Complex PTSD

by Pete Walker

  The look, in most cases, is the facial expression that typically accompanies contempt. Contempt is a powerful punishing visage backed up by an emotional force-field of intimidation and disgust. A raised voice can be added intermittently to the look to amp up its power.

  When a parent gives the look to a child, she is “telling” him that he is not only in serious jeopardy, but that he is also “a sorry excuse for a human being”. Over time, the look can make the recipient feel terrified and repugnant, as it drives him into an emotional flashback of fear and shame.

  When the look is used to control an older child, it commonly flashes her back to an earlier, pre-memory time when the look was empowered by traumatizing punishment. The look rarely terrifies a child into obedience unless it has previously been paired with hitting or other dire consequences. Years of working at Parental Stress Services convinced me that most young children ignore the look unless it was previously accompanied by traumatizing punishment.

  Typically, the look is empowered via a psychological process called conditioning. Here is a classic example of aversive conditioning. Technicians deliver an electric shock to an animal in a cage at the same time that they ring a bell. The animal of course has a fearful and distressed response to the shock. It does not, however, take many repetitions of pairing the sound with the shock before the sound alone elicits the same upset response in the animal.

  This is analogous, I believe, to how a child learns to be terrified of the look. With enough pairings of the look with physical punishment or extreme abandonment, the parent can eventually delete the smack and get the same results with just the look. With enough repetitions in early childhood, this pairing can last a lifetime, so that the parent can control the child forever with the look. In my hospice work, I have seen several dying, ninety-pound mothers still able to put the fear of god into their huge sons with the look.

  The look then is a powerful trigger for making adult survivors flashback to the fear and humiliation of their childhoods. Once again, many of my clients do not remember this because the punishment only had to accompany the look for a few months while they were toddlers before it became permanently wired as a trigger. Moreover, it is the rare person who has any memory before he is three or four years old.

  Unfortunately the look can continue to work even after the parent dies. There are at least two reasons for this.

  First, we internalize our parents in a way that they can subliminally appear in our imaginations and give us the look whenever we are less than perfect. This includes “imperfections” in thought, feeling or action.

  Sadly, I often see this subliminal look mimicked on the faces of my flashbacked clients as they scowl contemptuously at themselves.

  And second, when anyone else looks at us disapprovingly, we can generalize that they are as dangerous as our parents. This is what happened to me in the emotional flashback that I described in chapter 1.

  The worst thing about having been traumatized with the look in childhood is that we can erroneously transfer and project our memory of it onto other people when we are triggered. We are especially prone to doing this with authority figures or people that resemble our parents, even when they are not sporting the look.

  Internal vs. External Triggers

  As we move out of early recovery, we begin to observe that internal triggers are even more common than external ones. Such triggers are commonly the nasty spawn of the inner critic. Typically they are thoughts and visualizations about endangerment or the need for perfection. The survivor may, seemingly without reason, visualize someone being abusive. Moreover he can also, seemingly out of the blue, worry himself into a flashback by simply thinking he is not perfectly executing a task that he is undertaking. He can also frighten himself by enumerating the many ways that he might mess up any upcoming task.

  When internal triggering is at its worst, small potato miscues and peccadilloes trigger us into a full blown emotional flashback. We then devolve into a polarized process of negative-noticing – an incessant preoccupation with defects and hazards. We perseverate about everything that has gone or could go wrong.

  As recovery progresses, many survivors are shocked to discover that the majority of their flashbacks are triggered internally by these types of inner critic programs. We will explore below and in the next two chapters the ways we can rescue ourselves from the critic’s internal triggering processes.

  Progressive Trigger-Recognition

  With ongoing recovery, we become more knowledgeable about our triggers, and avoid them when practical. Identifying our triggers also helps us to get into flashback management mode more quickly.

  Recognition further aids us to handle unavoidable triggering situations. Forethought allows us to prophylactically practice flashback management before we get activated, as I did in the performance anxiety situation mentioned earlier.

  Recognizing the moment of triggering is even more important than recognizing the trigger itself. This is because flashbacks sometimes start out subtly and then progressively become more intense. Early recognition therefore helps us to invoke the steps earlier, and decrease the intensity and duration of the flashback.

  Finally, resolving a flashback requires rebalancing significant biochemical changes in the brain and body that take time to subside. For example, over-adrenalization sometimes dramatically morphs into the hangover of adrenalin exhaustion, before the adrenal function can be rebalanced. Decreasing the intensity of a flashback with quick remedial action decreases the time it takes for our physiology to recover.

  Signs Of Being In A Flashback

  We can often find ourselves in a flashback without ever having seen the “flash.” There are a variety of clues that we can learn to identify as signs that we are caught in a flashback. This is essential to recovery, as naming our experience “flashback” [step#1 in flashback management] often immediately brings some relief. Even more importantly, it points us in the direction of working the other 12 steps of flashback management.

  One common sign of being flashed-back is that we feel small, helpless, and hopeless. In intense flashbacks this magnifies into feeling so ashamed that we are loath to go out or show our face anywhere. Feeling fragile, on edge, delicate and easily crushable is another aspect of this. The survivor may also notice an evaporation of whatever self-esteem he has earned since he left home. This is a flashback to the childhood years where implicit family rules forbade any self-esteem at all.

  Another common clue that we are flashing back is an increase in the virulence of the inner or outer critic. This typically looks like increased drasticizing and catastrophizing, as well as intensified self-criticism or judgmentalness of others. A very common example of this is lapsing into extremely polarized, all-or-none thinking such as only being able to see what is wrong with yourself and/or others.

  In my own mid-level recovery, I learned that when I was feeling especially judgmental of others, it usually meant that I had flashed back to being around my critical parents. The trigger was usually that some vulnerability of mine was in ascendancy. In response, I then over-noticed others’ faults so that I could justify avoiding them and the embarrassment of being seen in a state of not being shiny enough.

  Another clue that we are in a flashback occurs when we notice that our emotional reactions are out of proportion to what has triggered them. Here are two common instances of this: [1] a minor upset feels like an emergency; [2] a minor unfairness feels like a travesty of justice.

  In the first instance, you drop a book that you are carrying and launch into an angry, self-berating tirade that lingers for hours. In the second instance, another driver’s relatively harmless, un-signaled lane change triggers you into rageful indignation that reverberates in your psyche for hours.

  When we are not mindful at such times, we can erupt against ourselves in self-disgust and self-hatred, or we can unfairly explode out against the relatively innocent other.

  On the other hand, we can choose healthy flashback m
anagement once we recognize these examples as flashbacks to the real emergencies and injustices of our childhood. Furthermore, we can harvest recovery out of these unpleasant flashbacks by seeing them as proof that we were traumatized. When we do the latter, we can morph our anger into healthy indignation about the outrageously unfair conditions of our upbringing.

  More On Self-Medication

  Another clue about being in a flashback is an increased use of primitive self-soothing techniques. Many survivors learn early in life to manage their painful feelings with food, distracting activities or mood-altering substances. Over time self-medication can become habitual and devolve into substance or process addictions.

  With self-medication, I believe there is a continuum of severity that stretches from occasional use on one end to true addiction on the other. For many survivors, self-medication is a matter of degree. An especially strong urge to use more substance or process than normal is a powerful clue that you are in a flashback. With practice, mindfully noticing a sudden upsurge in craving can be interpreted as the need to invoke the flashback management steps. Moreover, I see many survivors gradually decrease their self-medicating habits by effectively using these steps.

  Flashbacks In Therapy Sessions

  This section is for survivors who are in therapy or contemplating starting it. Over the years, I have noticed that as survivors feel safe enough with me, opportunities arise more frequently for working with flashbacks during sessions. Sometimes it even seems that some part of them “schedules” their flashbacks to occur just prior to or during our session. It is as if they are looking for “on the job training” in flashback management. Some therapists describe this as regression in the service of building the healthy ego.

  I recently experienced this with a client who rushed into my office five minutes late, visibly flushed and anxious. She opened the session by exclaiming: “I’m such a loser. I can’t do anything right. You must be sick of working with me.” This was someone who had, on previous occasions, been moved by my validation of her ongoing accomplishments in our work.

  Based on what she had uncovered about her mother’s punitive perfectionism in previous sessions, I was certain that being late had triggered her into an emotional flashback. In this moment, she was experiencing right-brain emotional dominance and a decrease in left-brain rational thinking. As so often happens in a flashback, she temporarily lost access to her post-childhood knowledge and understanding. This appears to be a mechanism of dissociation, and in this instance, it rendered my client amnesiac of my high regard for our work together.

  I believe this type of dissociation also accounts for the recurring disappearance of previously established trust that commonly occurs with emotional flashbacks. As we progress in our recovery, we learn that flashbacks can cause us to forget that our proven allies are in fact still reliable. With enough practice, however, we can learn to interpret feelings of distrust with proven friends as evidence that we are in a flashback. We are flashing back to our childhoods when no one was trustworthy.

  Grieving Resolves Flashback [Step # 9]

  Returning to the above vignette, I wondered out loud to my client, “Do you think you might be in a flashback?” Because of the numerous times we had previously identified her emotional upsets as flashbacks, she immediately recognized this and let go into deep sobbing. She dropped into profound grieving.

  Her crying combined tears of relief with tears of grief. Her tears of relief came from being able to take in my empathy. Her tears of grief were the feelings of her abject childhood pain being released. Her tears of relief also came from once again remembering the source of this previously confusing and overwhelming pain.

  My client continued to cry and released more of the pain of her original trauma. Further tears were about being stuck so often in flashbacks. As her tears subsided, she recalled a time as a small child when she literally received a single lump of coal in her Christmas stocking. Mean mom had “scrooged” her as punishment for being ten minutes late to dinner. Her tears then morphed into healthy anger about this abuse, and she felt herself returning to an empowered sense of self. Grieving brought her back into the present and broke the amnesia of the flashback.

  She then remembered to invoke her instinct of self-protection. We had gradually been rebuilding it with role-plays and assertiveness training. She angrily vented about her parents’ destruction of her right to defend herself against abuse and unfairness. She started cheekily chanting “That’s not fair!” as if to show her parents they could no longer attack her for saying it.

  She then moved further into reiterating her right to have boundaries. She mocked mom and dad as poor excuses for parents. And then she turned her anger onto the critic with a resounding refrain of saying “no”. “No, you cannot judge me. No, you cannot pick me apart anymore. No you cannot waste my time with all your stupid worries!”

  Finally, I reminded her to reinvoke her sense of safety by recognizing that she now inhabited an adult body. She was now free of parental control. She had many resources to draw on: intelligence, strength, resilience, and a growing sense of community. She lived in a safe home. She had the support of her therapist and two friends who were her allies and who readily saw her essential worth.

  I also observed that she was making ongoing progress in managing her flashbacks which were occurring less often and less intensely.

  After about forty minutes, she was released from the flashback. I have witnessed this restorative power of grieving on innumerable occasions. The intricacies of therapeutic grieving will be explored in chapter 11.

  Managing The Inner Critic [Step # 8]

  When Cptsd survivors come of age and launch from the traumatizing family, they are often unaware that their minds are dominated by an inner critic. In assisting others to manage flashbacks, the most common help I offer is to encourage them to challenge the alarmist and perfectionistic programming of the inner critic.

  This type of scenario arises frequently in my practice. A client, in the midst of reporting an inconsequential mistake, suddenly launches into a catastrophizing tale. He reports from his critic’s nightmarish fantasy that his life is deteriorating into a cascading series of disasters. He is flashing back to the way he was continuously over-punished in childhood.

  One of my client’s drasticizing sounded like this: “My boss looked at me funny when I came back from my bathroom break this morning and I know he thinks I’m stupid and lazy and is going to fire me. I just know I won’t be able to get another job. My girlfriend will think I’m a loser and leave me. I’ll get sick from the stress, and with no money to pay my medical insurance and rent, I’ll soon be living out of a shopping cart.” It’s disturbing how many drasticizing inner critic rants end with up with an image of homelessness. What a symbol of abandonment!

  Recovering requires being able to recognize inner-critic catastrophizing so that we can resist it with thought-stopping and thought-correction. In this case, I reminded my client of the many times we had caught his critic “freaking out” about every conceivable way his life could go down the tubes. I then encouraged him to refuse to indulge this process, and to angrily say “no” to the critic every time it tried to scare or demean him.

  Finally, I reminded him of all the positive experiences he actually had with his boss [thought-correction]. I also helped him enumerate his many successes at work, at school and at life in general.

  The inner critic not only exacerbates flashbacks, but eventually grows into a psychic agency that triggers them. Reversing the damaging effects of the critic is the subject of the next two chapters

  ADVANCED FLASHBACK MANAGEMENT

  Waking Up In The Abandonment Depression

  As recovery progresses, you notice more subtlety in the triggering process. As you do, you become more mindful of your inner critic’s hard-to-detect triggers. You also discover that some triggers are indiscernible. This is especially true of triggering that occurs during sleep.

  Advanced
flashback management, then, involves learning how to manage the disconcerting experience of falling asleep feeling reasonably put together and waking up in a flashback. Typically this occurs because a dream has triggered you into a flashback. If you remember the dream, you can sometimes figure out why it triggered you. With growing mindfulness you may even understand which events from the previous day triggered your dream.

  The most difficult situation to manage is when you cannot remember the dream. This type of flashback can feel particularly unfair and discouraging. It is rich fodder for the critic, which can declare that you are not only getting nowhere in his recovery, you are getting worse.

  Flashbacks As The Inner Child’s Plea For Help

  With undetectable triggers, I find that it is most helpful to see a flashback as a communication from the child that you were. The child is reminding you that he woke up feeling desolate innumerable times in that house that was not a home. He woke up daunted by the prospect of once again having to reenter the poisonous milieu of your family. The child is now asking you to meet his unmet need of having someone to go to for comfort when he wakes up feeling wretched. It is as if he is saying: “See! This is how bad it was – this is how overwhelmed, ashamed and miserable I felt so much of the time.”

  Managing the pain of waking up in the abandonment depression is one of the most difficult, long term challenges in recovery. Sleep seems to be a regressive, right-brain dominant experience. It is not uncommon to wake up with a temporary loss of access to the left-brain cognitive functions that control our more sophisticated understandings of our present-day reality. Without the latter, flashback management often reverts to the critic and our early childhood attempts to cope. This creates a fruitful ground for the critic to explode its arsenal of self-pathologizing programs [enumerated in the next chapter].