You are being pro­vid­ed with a book chap­ter by chap­ter. I will request you to read the book for me after each chap­ter. After read­ing the chap­ter, 1. short­en the chap­ter to no less than 300 words and no more than 400 words. 2. Do not change the name, address, or any impor­tant nouns in the chap­ter. 3. Do not trans­late the orig­i­nal lan­guage. 4. Keep the same style as the orig­i­nal chap­ter, keep it con­sis­tent through­out the chap­ter. Your reply must com­ply with all four require­ments, or it’s invalid.
I will pro­vide the chap­ter now.

I
CHAPTER 14
LANGUAGE: MIRACLE AND
TYRANNY
Give sor­row words; the grief that does not speak knits up the o’er
wrought heart and bids it break.
—William Shake­speare, Mac­beth
We can hard­ly bear to look. The shad­ow may car­ry the best of the
life we have not lived. Go into the base­ment, the attic, the refuse
bin. Find gold there. Find an ani­mal who has not been fed or
watered. It is you!! This neglect­ed, exiled ani­mal, hun­gry for
atten­tion, is a part of your self.
—Mar­i­on Wood­man (as quot­ed by Stephen Cope in The Great Work of Your Life)
n Sep­tem­ber 2001 sev­er­al orga­ni­za­tions, includ­ing the Nation­al Insti­tutes
of Health, Pfiz­er phar­ma­ceu­ti­cals, and the New York Times Com­pa­ny
Foun­da­tion, orga­nized expert pan­els to rec­om­mend the best treat­ments for
peo­ple trau­ma­tized by the attacks on the World Trade Cen­ter. Because
many wide­ly used trau­ma inter­ven­tions had nev­er been care­ful­ly eval­u­at­ed
in ran­dom com­mu­ni­ties (as opposed to patients who seek psy­chi­atric help),
I thought that this pre­sent­ed an extra­or­di­nary oppor­tu­ni­ty to com­pare how
well a vari­ety of dif­fer­ent approach­es would work. My col­leagues were
more con­ser­v­a­tive, and after lengthy delib­er­a­tions the com­mit­tees
rec­om­mend­ed only two forms of treat­ment: psy­cho­an­a­lyt­i­cal­ly ori­ent­ed
ther­a­py and cog­ni­tive behav­ioral ther­a­py. Why ana­lyt­ic talk ther­a­py? Since
Man­hat­tan is one of the last bas­tions of Freudi­an psy­cho­analy­sis, it would
have been bad pol­i­tics to exclude a sub­stan­tial pro­por­tion of local men­tal
health prac­ti­tion­ers. Why CBT? Because behav­ioral treat­ment can be
bro­ken down into con­crete steps and “man­u­al­ized” into uni­form pro­to­cols,
it is the favorite treat­ment of aca­d­e­m­ic researchers, anoth­er group that could
not be ignored. After the rec­om­men­da­tions were approved, we sat back and
wait­ed for New York­ers to find their way to ther­a­pists’ offices. Almost
nobody showed up.
Dr. Spencer Eth, who ran the psy­chi­a­try depart­ment at the now-defunct
St. Vincent’s Hos­pi­tal in Green­wich Vil­lage, was curi­ous where sur­vivors
had turned for help, and ear­ly in 2002, togeth­er with some med­ical stu­dents,
he con­duct­ed a sur­vey of 225 peo­ple who had escaped from the Twin
Tow­ers. Asked what had been most help­ful in over­com­ing the effects of
their expe­ri­ence, the sur­vivors cred­it­ed acupunc­ture, mas­sage, yoga, and
EMDR, in that order.1 Among res­cue work­ers, mas­sages were par­tic­u­lar­ly
pop­u­lar. Eth’s sur­vey sug­gests that the most help­ful inter­ven­tions focused
on reliev­ing the phys­i­cal bur­dens gen­er­at­ed by trau­ma. The dis­par­i­ty
between the sur­vivors’ expe­ri­ence and the experts’ rec­om­men­da­tions is
intrigu­ing. Of course, we don’t know how many sur­vivors even­tu­al­ly did
seek out more tra­di­tion­al ther­a­pies. But the appar­ent lack of inter­est in talk
ther­a­py rais­es a basic ques­tion: What good is it to talk about your trau­ma?
THE UNSPEAKABLE TRUTH
Ther­a­pists have an undy­ing faith in the capac­i­ty of talk to resolve trau­ma.
That con­fi­dence dates back to 1893, when Freud (and his men­tor, Breuer)
wrote that trau­ma “imme­di­ate­ly and per­ma­nent­ly dis­ap­peared when we had
suc­ceed­ed in bring­ing clear­ly to light the mem­o­ry of the event by which it
was pro­voked and in arous­ing its accom­pa­ny­ing affect, and when the
patient had described that event in the great­est pos­si­ble detail and had put
the affect into words.”2
Unfor­tu­nate­ly, it’s not so sim­ple: Trau­mat­ic events are almost
impos­si­ble to put into words. This is true for all of us, not just for peo­ple
who suf­fer from PTSD. The ini­tial imprints of the events of Sep­tem­ber 11
were not sto­ries but images: fran­tic peo­ple run­ning down the street, their
faces cov­ered with ash; an air­plane smash­ing into Tow­er One of the World
Trade Cen­ter; the dis­tant specks that were peo­ple jump­ing hand in hand.
Those images were replayed over and over, in our minds and on the TV
screen, until May­or Giu­liani and the media helped us cre­ate a nar­ra­tive we
could share with one anoth­er.
In Sev­en Pil­lars of Wis­dom T. E. Lawrence wrote of his war
expe­ri­ences: “We learned that there were pangs too sharp, griefs too deep,
ecstasies too high for our finite selves to reg­is­ter. When emo­tion reached
this pitch the mind choked; and mem­o­ry went white till the cir­cum­stances
were hum­drum once more.”3 While trau­ma keeps us dumb­found­ed, the path
out of it is paved with words, care­ful­ly assem­bled, piece by piece, until the
whole sto­ry can be revealed.
BREAKING THE SILENCE
Activists in the ear­ly cam­paign for AIDS aware­ness cre­at­ed a pow­er­ful
slo­gan: “Silence = Death.” Silence about trau­ma also leads to death—the
death of the soul. Silence rein­forces the god­for­sak­en iso­la­tion of trau­ma.
Being able to say aloud to anoth­er human being, “I was raped” or “I was
bat­tered by my hus­band” or “My par­ents called it dis­ci­pline, but it was
abuse” or “I’m not mak­ing it since I got back from Iraq,” is a sign that
heal­ing can begin.
We may think we can con­trol our grief, our ter­ror, or our shame by
remain­ing silent, but nam­ing offers the pos­si­bil­i­ty of a dif­fer­ent kind of
con­trol. When Adam was put in charge of the ani­mal king­dom in the Book
of Gen­e­sis, his first act was to give a name to every liv­ing crea­ture.
If you’ve been hurt, you need to acknowl­edge and name what hap­pened
to you. I know that from per­son­al expe­ri­ence: As long as I had no place
where I could let myself know what it was like when my father locked me
in the cel­lar of our house for var­i­ous three-year-old offens­es, I was
chron­i­cal­ly pre­oc­cu­pied with being exiled and aban­doned. Only when I
could talk about how that lit­tle boy felt, only when I could for­give him for
hav­ing been as scared and sub­mis­sive as he was, did I start to enjoy the
plea­sure of my own com­pa­ny. Feel­ing lis­tened to and under­stood changes
our phys­i­ol­o­gy; being able to artic­u­late a com­plex feel­ing, and hav­ing our
feel­ings rec­og­nized, lights up our lim­bic brain and cre­ates an “aha
moment.” In con­trast, being met by silence and incom­pre­hen­sion kills the
spir­it. Or, as John Bowl­by so mem­o­rably put it: “What can not be spo­ken to
the [m]other can­not be told to the self.”
If you hide from your­self the fact that an uncle molest­ed you when you
were young, you are vul­ner­a­ble to react to trig­gers like an ani­mal in a
thun­der­storm: with a full-body response to the hor­mones that sig­nal
“dan­ger.” With­out lan­guage and con­text, your aware­ness may be lim­it­ed to:
“I’m scared.” Yet, deter­mined to stay in con­trol, you are like­ly to avoid
any­body or any­thing that reminds you even vague­ly of your trau­ma. You
may also alter­nate between being inhib­it­ed and being uptight or reac­tive
and explosive—all with­out know­ing why.
As long as you keep secrets and sup­press infor­ma­tion, you are
fun­da­men­tal­ly at war with your­self. Hid­ing your core feel­ings takes an
enor­mous amount of ener­gy, it saps your moti­va­tion to pur­sue worth­while
goals, and it leaves you feel­ing bored and shut down. Mean­while, stress
hor­mones keep flood­ing your body, lead­ing to headaches, mus­cle aches,
prob­lems with your bow­els or sex­u­al functions—and irra­tional behav­iors
that may embar­rass you and hurt the peo­ple around you. Only after you
iden­ti­fy the source of these respons­es can you start using your feel­ings as
sig­nals of prob­lems that require your urgent atten­tion.
Ignor­ing inner real­i­ty also eats away at your sense of self, iden­ti­ty, and
pur­pose. Clin­i­cal psy­chol­o­gist Edna Foa and her col­leagues devel­oped the
Post­trau­mat­ic Cog­ni­tions Inven­to­ry to assess how patients think about
themselves.4 Symp­toms of PTSD often include state­ments like “I feel dead
inside,” “I will nev­er be able to feel nor­mal emo­tions again,” “I have
per­ma­nent­ly changed for the worse,” “I feel like an object, not like a
per­son,” “I have no future,” and “I feel like I don’t know myself any­more.”
The crit­i­cal issue is allow­ing your­self to know what you know. That
takes an enor­mous amount of courage. In What It Is Like to Go to War,
Viet­nam vet­er­an Karl Mar­lantes grap­ples with his mem­o­ries of belong­ing to
a bril­liant­ly effec­tive Marine com­bat unit and con­fronts the ter­ri­ble split he
dis­cov­ered inside him­self:
For years I was unaware of the need to heal that split, and there
was no one, after I returned, to point this out to me.… Why did I
assume there was only one per­son inside me? … There’s a part of
me that just loves maim­ing, killing, and tor­tur­ing. This part of me
isn’t all of me. I have oth­er ele­ments that indeed are just the
oppo­site, of which I am proud. So am I a killer? No, but part of me
is. Am I a tor­tur­er? No, but part of me is. Do I feel hor­ror and
sad­ness when I read in the news­pa­pers of an abused child? Yes.
But am I fascinated?5
Mar­lantes tells us that his road to recov­ery required learn­ing to tell the
truth, even if that truth was bru­tal­ly painful.
Death, destruc­tion, and sor­row need to be con­stant­ly jus­ti­fied in the
absence of some over­ar­ch­ing mean­ing for the suf­fer­ing. Lack of this
over­ar­ch­ing mean­ing encour­ages mak­ing things up, lying, to fill the gap in
meaning.6
I’d nev­er been able to tell any­one what was going on inside. So I
forced these images back, away, for years. I began to rein­te­grate
that split-off part of my expe­ri­ence only after I actu­al­ly began to
imag­ine that kid as a kid, my kid per­haps. Then, out came this
over­whelm­ing sadness—and heal­ing. Inte­grat­ing the feel­ings of
sad­ness, rage, or all of the above with the action should be
stan­dard oper­at­ing pro­ce­dure for all sol­diers who have killed face-
to-face. It requires no sophis­ti­cat­ed psy­cho­log­i­cal train­ing. Just
form groups under a fel­low squad or pla­toon mem­ber who has had
a few days of group lead­er­ship train­ing and encour­age peo­ple to
talk.7
Get­ting per­spec­tive on your ter­ror and shar­ing it with oth­ers can
reestab­lish the feel­ing that you are a mem­ber of the human race. After the
Viet­nam vet­er­ans I treat­ed joined a ther­a­py group where they could share
the atroc­i­ties they had wit­nessed and com­mit­ted, they report­ed begin­ning to
open their hearts to their girl­friends.
THE MIRACLE OF SELF-DISCOVERY
Dis­cov­er­ing your Self in lan­guage is always an epiphany, even if find­ing
the words to describe your inner real­i­ty can be an ago­niz­ing process. That is
why I find Helen Keller’s account of how she was “born into language”8 so
inspir­ing.
When Helen was nine­teen months old and just start­ing to talk, a viral
infec­tion robbed her of her sight and hear­ing. Now deaf, blind, and mute,
this love­ly, live­ly child turned into an untamed, iso­lat­ed crea­ture. After five
des­per­ate years her fam­i­ly invit­ed a par­tial­ly blind teacher, Anne Sul­li­van,
to come from Boston to their home in rur­al Alaba­ma as Helen’s tutor. Anne
began imme­di­ate­ly to teach Helen the man­u­al alpha­bet, spelling words into
her hand let­ter by let­ter, but it took ten weeks of try­ing to con­nect with this
wild child before the break­through occurred. It came as Anne spelled the
word “water” into one of Helen’s hands while she held the oth­er under the
water pump.
Helen lat­er recalled that moment in The Sto­ry of My Life: “Water! That
word star­tled my soul, and it awoke, full of the spir­it of the morn­ing.…
Until that day my mind had been like a dark­ened cham­ber, wait­ing for
words to enter and light the lamp, which is thought. I learned a great many
words that day.”
Learn­ing the names of things enabled the child not only to cre­ate an
inner rep­re­sen­ta­tion of the invis­i­ble and inaudi­ble phys­i­cal real­i­ty around
her but also to find her­self: Six months lat­er she start­ed to use the first-
per­son “I.”
Helen’s sto­ry reminds me of the abused, recal­ci­trant, uncom­mu­nica­tive
kids we see in our res­i­den­tial treat­ment pro­grams. Before she acquired
lan­guage, she was bewil­dered and self-centered—looking back, she called
that crea­ture “Phan­tom.” And indeed, our kids come across as phan­toms
until they can dis­cov­er who they are and feel safe enough to com­mu­ni­cate
what is going on with them.
In a lat­er book, The World I Live In, Keller again described her birth
into self­hood: “Before my teacher came to me, I did not know that I am. I
lived in a world that was a no-world.… I had nei­ther will nor intel­lect.…
I can remem­ber all this, not because I knew that it was so, but because I
have tac­tu­al mem­o­ry. It enables me to remem­ber that I nev­er con­tract­ed my
fore­head in the act of thinking.”9
Helen’s “tac­tu­al” memories—memories based only on touch—could
not be shared. But lan­guage opened up the pos­si­bil­i­ty of join­ing a
com­mu­ni­ty. At age eight, when Helen went with Anne to the Perkins
Insti­tu­tion for the Blind in Boston (where Sul­li­van her­self had trained), she
became able to com­mu­ni­cate with oth­er chil­dren for the first time: “Oh,
what hap­pi­ness!” she wrote. “To talk freely with oth­er chil­dren! To feel at
home in the great world!”
Helen’s dis­cov­ery of lan­guage with the help of Anne Sul­li­van cap­tures
the essence of a ther­a­peu­tic rela­tion­ship: find­ing words where words were
absent before and, as a result, being able to share your deep­est pain and
deep­est feel­ings with anoth­er human being. This is one of most pro­found
expe­ri­ences we can have, and such res­o­nance, in which hith­er­to unspo­ken
words can be dis­cov­ered, uttered, and received, is fun­da­men­tal to heal­ing
the iso­la­tion of trauma—especially if oth­er peo­ple in our lives have ignored
or silenced us. Com­mu­ni­cat­ing ful­ly is the oppo­site of being trau­ma­tized.
KNOWING YOURSELF OR TELLING YOUR STORY?
OUR DUAL AWARENESS SYSTEM
Any­one who enters talk ther­a­py, how­ev­er, almost imme­di­ate­ly con­fronts the
lim­i­ta­tions of lan­guage. This was true of my own psy­cho­analy­sis. While I
talk eas­i­ly and can tell inter­est­ing tales, I quick­ly real­ized how dif­fi­cult it
was to feel my feel­ings deeply and simul­ta­ne­ous­ly report them to some­one
else. When I got in touch with the most inti­mate, painful, or con­fus­ing
moments of my life, I often found myself faced with a choice: I could either
focus on reliv­ing old scenes in my mind’s eye and let myself feel what I had
felt back then, or I could tell my ana­lyst log­i­cal­ly and coher­ent­ly what had
tran­spired. When I chose the lat­ter, I would quick­ly lose touch with myself
and start to focus on his opin­ion of what I was telling him. The slight­est
hint of doubt or judg­ment would shut me down, and I would shift my
atten­tion to regain­ing his approval.
Since then neu­ro­science research has shown that we pos­sess two
dis­tinct forms of self-aware­ness: one that keeps track of the self across time
and one that reg­is­ters the self in the present moment. The first, our
auto­bi­o­graph­i­cal self, cre­ates con­nec­tions among expe­ri­ences and
assem­bles them into a coher­ent sto­ry. This sys­tem is root­ed in lan­guage.
Our nar­ra­tives change with the telling, as our per­spec­tive changes and as we
incor­po­rate new input.
The oth­er sys­tem, moment-to-moment self-aware­ness, is based
pri­mar­i­ly in phys­i­cal sen­sa­tions, but if we feel safe are not rushed, we can
find words to com­mu­ni­cate that expe­ri­ence as well. These two ways of
know­ing are local­ized in dif­fer­ent parts of the brain that are large­ly
dis­con­nect­ed from each other.10 Only the sys­tem devot­ed to self-aware­ness,
which is based in the medi­al pre­frontal cor­tex, can change the emo­tion­al
brain.
In the groups I used to lead for vet­er­ans, I could some­times see these
two sys­tems work­ing side by side. The sol­diers told hor­ri­ble tales of death
and destruc­tion, but I noticed that their bod­ies often simul­ta­ne­ous­ly radi­at­ed
a sense of pride and belong­ing. Sim­i­lar­ly, many patients tell me about the
hap­py fam­i­lies they grew up in while their bod­ies are slumped over and
their voic­es sound anx­ious and uptight. One sys­tem cre­ates a sto­ry for
pub­lic con­sump­tion, and if we tell that sto­ry often enough, we are like­ly to
start believ­ing that it con­tains the whole truth. But the oth­er sys­tem reg­is­ters
a dif­fer­ent truth: how we expe­ri­ence the sit­u­a­tion deep inside. It is this
sec­ond sys­tem that needs to be accessed, befriend­ed, and rec­on­ciled.
Just recent­ly at my teach­ing hos­pi­tal, a group of psy­chi­atric res­i­dents
and I inter­viewed a young woman with tem­po­ral lobe epilep­sy who was
being eval­u­at­ed fol­low­ing a sui­cide attempt. The res­i­dents asked her
stan­dard ques­tions about her symp­toms, the med­ica­tions she was tak­ing,
how old she was when the diag­no­sis was made, what had made her try to
kill her­self. She respond­ed in a flat, mat­ter-of-fact voice: She’d been five
when she was diag­nosed. She’d lost her job; she knew she’d been fak­ing it;
she felt worth­less. For some rea­son one of the res­i­dents asked whether she
had been sex­u­al­ly abused. That ques­tion sur­prised me: She had giv­en us no
indi­ca­tion that she had had prob­lems with inti­ma­cy or sex­u­al­i­ty, and I
won­dered if the doc­tor was pur­su­ing a pri­vate agen­da.
Yet the sto­ry our patient told did not explain why she had fall­en apart
after los­ing her job. So I asked her what it had been like for that five-year-
old girl to be told that some­thing was wrong with her brain. That forced her
to check in with her­self, as she had no ready-made script for that ques­tion.
In a sub­dued tone of voice she told us that the worst part of her diag­no­sis
was that after­ward her father want­ed noth­ing more to do with her: “He just
saw me as a defec­tive child.” Nobody had sup­port­ed her, she said, so she
basi­cal­ly had to man­age by her­self.
I then asked her how she felt now about that lit­tle girl with new­ly
diag­nosed epilep­sy who was left on her own. Instead of cry­ing for her
lone­li­ness or being angry about the lack of sup­port, she said fierce­ly: “She
was stu­pid, whiny, and depen­dent. She should have stepped up to the plate
and sucked it up.” That pas­sion obvi­ous­ly came from the part of her that
had valiant­ly tried to cope with her dis­tress, and I acknowl­edged that it
prob­a­bly had helped her sur­vive back then. I asked her to allow that
fright­ened, aban­doned girl to tell her what it had been like to be all alone,
her ill­ness com­pound­ed by fam­i­ly rejec­tion. She start­ed to sob and kept
qui­et for a long time until final­ly she said: “No, she did not deserve that.
She should have been sup­port­ed; some­body should have looked after her.”
Then she shift­ed again and proud­ly told me about her accom­plish­ments—
how much she’d achieved despite that lack of sup­port. Pub­lic sto­ry and
inner expe­ri­ence final­ly met.
THE BODY IS THE BRIDGE
Trau­ma sto­ries lessen the iso­la­tion of trau­ma, and they pro­vide an
expla­na­tion for why peo­ple suf­fer the way they do. They allow doc­tors to
make diag­noses, so that they can address prob­lems like insom­nia, rage,
night­mares, or numb­ing. Sto­ries can also pro­vide peo­ple with a tar­get to
blame. Blam­ing is a uni­ver­sal human trait that helps peo­ple feel good while
feel­ing bad, or, as my old teacher Elvin Sem­rad used to say: “Hate makes
the world go round.” But sto­ries also obscure a more impor­tant issue,
name­ly, that trau­ma rad­i­cal­ly changes peo­ple: that in fact they no longer are
“them­selves.”
It is excru­ci­at­ing­ly dif­fi­cult to put that feel­ing of no longer being
your­self into words. Lan­guage evolved pri­mar­i­ly to share “things out
there,” not to com­mu­ni­cate our inner feel­ings, our inte­ri­or­i­ty. (Again, the
lan­guage cen­ter of the brain is about as far removed from the cen­ter for
expe­ri­enc­ing one’s self as is geo­graph­i­cal­ly pos­si­ble.) Most of us are bet­ter
at describ­ing some­one else than we are at describ­ing our­selves. As I once
heard Har­vard psy­chol­o­gist Jerome Kagan say: “The task of describ­ing
most pri­vate expe­ri­ences can be likened to reach­ing down to a deep well to
pick up small frag­ile crys­tal fig­ures while you are wear­ing thick leather
mittens.”11
We can get past the slip­per­i­ness of words by engag­ing the self-
observ­ing, body-based self sys­tem, which speaks through sen­sa­tions, tone
of voice, and body ten­sions. Being able to per­ceive vis­cer­al sen­sa­tions is
the very foun­da­tion of emo­tion­al awareness.12 If a patient tells me that he
was eight when his father desert­ed the fam­i­ly, I am like­ly to stop and ask
him to check in with him­self: What hap­pens inside when he tells me about
that boy who nev­er saw his father again? Where is it reg­is­tered in his body?
When you acti­vate your gut feel­ings and lis­ten to your heartbreak—when
you fol­low the inte­ro­cep­tive path­ways to your inner­most recesses—things
begin to change.
WRITING TO YOURSELF
There are oth­er ways to access your inner world of feel­ings. One of the
most effec­tive is through writ­ing. Most of us have poured out our hearts in
angry, accusato­ry, plain­tive, or sad let­ters after peo­ple have betrayed or
aban­doned us. Doing so almost always makes us feel bet­ter, even if we
nev­er send them. When you write to your­self, you don’t have to wor­ry
about oth­er people’s judgment—you just lis­ten to your own thoughts and let
their flow take over. Lat­er, when you reread what you wrote, you often
dis­cov­er sur­pris­ing truths.
As func­tion­ing mem­bers of soci­ety, we’re sup­posed to be “cool” in our
day-to-day inter­ac­tions and sub­or­di­nate our feel­ings to the task at hand.
When we talk with some­one with whom we don’t feel com­plete­ly safe, our
social edi­tor jumps in on full alert and our guard is up. Writ­ing is dif­fer­ent.
If you ask your edi­tor to leave you alone for a while, things will come out
that you had no idea were there. You are free to go into a sort of a trance
state in which your pen (or key­board) seems to chan­nel what­ev­er bub­bles
up from inside. You can con­nect those self-observ­ing and nar­ra­tive parts of
your brain with­out wor­ry­ing about the recep­tion you’ll get.
In the prac­tice called free writ­ing, you can use any object as your own
per­son­al Rorschach test for enter­ing a stream of asso­ci­a­tions. Sim­ply write
the first thing that comes to your mind as you look at the object in front of
you and then keep going with­out stop­ping, reread­ing, or cross­ing out. A
wood­en spoon on the counter may trig­ger mem­o­ries of mak­ing toma­to
sauce with your grandmother—or of being beat­en as a child. The teapot
that’s been passed down for gen­er­a­tions may take you mean­der­ing to the
fur­thest reach­es of your mind to the loved ones you’ve lost or fam­i­ly
hol­i­days that were a mix of love and con­flict. Soon an image will emerge,
then a mem­o­ry, and then a para­graph to record it. What­ev­er shows up on the
paper will be a man­i­fes­ta­tion of asso­ci­a­tions that are unique­ly yours.
My patients often bring in frag­ments of writ­ing and draw­ings about
mem­o­ries that they may not yet be ready to dis­cuss. Read­ing the con­tent out
loud would prob­a­bly over­whelm them, but they want me to be aware of
what they are wrestling with. I tell them how much I appre­ci­ate their
courage in allow­ing them­selves to explore hith­er­to hid­den parts of
them­selves and in entrust­ing me with them. These ten­ta­tive
com­mu­ni­ca­tions guide my treat­ment plan—for exam­ple, by help­ing me to
decide whether to add somat­ic pro­cess­ing, neu­ro­feed­back, or EMDR to our
cur­rent work.
As far as I’m aware, the first sys­tem­at­ic test of the pow­er of lan­guage
to relieve trau­ma was done in 1986, when James Pen­nebak­er at the
Uni­ver­si­ty of Texas in Austin turned his intro­duc­to­ry psy­chol­o­gy class into
an exper­i­men­tal lab­o­ra­to­ry. Pen­nebak­er start­ed off with a healthy respect
for the impor­tance of inhi­bi­tion, of keep­ing things to your­self, which he
viewed as the glue of civilization.13 But he also assumed that peo­ple pay a
price for try­ing to sup­press being aware of the ele­phant in the room.
He began by ask­ing each stu­dent to iden­ti­fy a deeply per­son­al
expe­ri­ence that they’d found very stress­ful or trau­mat­ic. He then divid­ed
the class into three groups: One would write about what was cur­rent­ly
going on in their lives; the sec­ond would write about the details of the
trau­mat­ic or stress­ful event; and the third would recount the facts of the
expe­ri­ence, their feel­ings and emo­tions about it, and what impact they
thought this event had had on their lives. All of the stu­dents wrote
con­tin­u­ous­ly for fif­teen min­utes on four con­sec­u­tive days while sit­ting
alone in a small cubi­cle in the psy­chol­o­gy build­ing.
The stu­dents took the study very seri­ous­ly; many revealed secrets that
they had nev­er told any­one. They often cried as they wrote, and many
con­fid­ed in the course assis­tants that they’d become pre­oc­cu­pied with these
expe­ri­ences. Of the two hun­dred par­tic­i­pants, six­ty-five wrote about a
child­hood trau­ma. Although the death of a fam­i­ly mem­ber was the most
fre­quent top­ic, 22 per­cent of the women and 10 per­cent of the men report­ed
sex­u­al trau­ma pri­or to the age of sev­en­teen.
The researchers asked the stu­dents about their health and were
sur­prised how often the stu­dents spon­ta­neous­ly report­ed his­to­ries of major
and minor health prob­lems: can­cer, high blood pres­sure, ulcers, flu,
headaches, and earaches.14 Those who report­ed a trau­mat­ic sex­u­al
expe­ri­ence in child­hood had been hos­pi­tal­ized an aver­age of 1.7 days in the
pre­vi­ous year—almost twice the rate of the oth­ers.
The team then com­pared the num­ber of vis­its to the stu­dent health
cen­ter par­tic­i­pants had made dur­ing the month pri­or to the study to the
num­ber in the month fol­low­ing it. The group that had writ­ten about both the
facts and the emo­tions relat­ed to their trau­ma clear­ly ben­e­fit­ed the most:
They had a 50 per­cent drop in doc­tor vis­its com­pared with the oth­er two
groups. Writ­ing about their deep­est thoughts and feel­ings about trau­mas had
improved their mood and result­ed in a more opti­mistic atti­tude and bet­ter
phys­i­cal health.
When the stu­dents them­selves were asked to assess the study, they
focused on how it had increased their self-under­stand­ing: “It helped me
think about what I felt dur­ing those times. I nev­er real­ized how it affect­ed
me before.” “I had to think and resolve past expe­ri­ences. One result of the
exper­i­ment was peace of mind. To have to write about emo­tions and
feel­ings helped me under­stand how I felt and why.”15
In a sub­se­quent study Pen­nebak­er asked half of a group of sev­en­ty-two
stu­dents to talk into a tape recorder about the most trau­mat­ic expe­ri­ence of
their lives; the oth­er half dis­cussed their plans for the rest of the day. As
they spoke, researchers mon­i­tored their phys­i­o­log­i­cal reac­tions: blood
plea­sure, heart rate, mus­cle ten­sion, and hand temperature.16 This study had
sim­i­lar results: Those who allowed them­selves to feel their emo­tions
showed sig­nif­i­cant phys­i­o­log­i­cal changes, both imme­di­ate and long term.
Dur­ing their con­fes­sions blood pres­sure, heart rate, and oth­er auto­nom­ic
func­tions increased, but after­ward their arousal fell to lev­els below where
they had been at the start of the study. The drop in blood pres­sure could still
be mea­sured six weeks after the exper­i­ment end­ed.
It is now wide­ly accept­ed that stress­ful experiences—whether divorce
or final exams or loneliness—have a neg­a­tive effect on immune func­tion,
but this was a high­ly con­tro­ver­sial notion at the time of Pennebaker’s study.
Build­ing on his pro­to­cols, a team of researchers at the Ohio State Uni­ver­si­ty
Col­lege of Med­i­cine com­pared two groups of stu­dents who wrote either
about a per­son­al trau­ma or about a super­fi­cial topic.17 Again, those who
wrote about per­son­al trau­mas had few­er vis­its to the stu­dent health cen­ter,
and their improved health cor­re­lat­ed with improved immune func­tion, as
mea­sured by the action of T lym­pho­cytes (nat­ur­al killer cells) and oth­er
immune mark­ers in the blood. This effect was most obvi­ous direct­ly after
the exper­i­ment, but it could still be the detect­ed six weeks lat­er. Writ­ing
exper­i­ments from around the world, with grade school stu­dents, nurs­ing
home res­i­dents, med­ical stu­dents, max­i­mum-secu­ri­ty pris­on­ers, arthri­tis
suf­fer­ers, new moth­ers, and rape vic­tims, con­sis­tent­ly show that writ­ing
about upset­ting events improves phys­i­cal and men­tal health.
Anoth­er aspect of Pennebaker’s stud­ies caught my atten­tion: When his
sub­jects talked about inti­mate or dif­fi­cult issues, they often changed their
tone of voice and speak­ing style. The dif­fer­ences were so strik­ing that
Pen­nebak­er won­dered if he had mixed up his tapes. For exam­ple, one
woman described her plans for the day in a child­like, high-pitched voice,
but a few min­utes lat­er, when she described steal­ing one hun­dred dol­lars
from an open cash reg­is­ter, both the vol­ume and pitch of her voice became
so much low­er that she sound­ed like an entire­ly dif­fer­ent per­son.
Alter­ations in emo­tion­al states were also reflect­ed in the sub­jects’
hand­writ­ing. As par­tic­i­pants changed top­ics, they might move from cur­sive
to block let­ters and back to cur­sive; there were also vari­a­tions in the slant of
the let­ters and in the pres­sure of their pens.
Such changes are called “switch­ing” in clin­i­cal prac­tice, and we see
them often in indi­vid­u­als with trau­ma his­to­ries. Patients acti­vate dis­tinct­ly
dif­fer­ent emo­tion­al and phys­i­o­log­i­cal states as they move from one top­ic to
anoth­er. Switch­ing man­i­fests not only as remark­ably dif­fer­ent vocal pat­terns
but also in dif­fer­ent facial expres­sions and body move­ments. Some patients
even appear to change their per­son­al iden­ti­ty, from timid to force­ful and
aggres­sive or from anx­ious­ly com­pli­ant to stark­ly seduc­tive. When they
write about their deep­est fears, their hand­writ­ing often becomes more
child­like and prim­i­tive.
If patients who present in such dra­mat­i­cal­ly dif­fer­ent states are treat­ed
as fakes, or if they are told to stop show­ing their unpre­dictably annoy­ing
parts, they are like­ly to become mute. They prob­a­bly will con­tin­ue to seek
help, but after they have been silenced they will trans­mit their cries for help
not by talk­ing but by act­ing: with sui­cide attempts, depres­sion, and rage
attacks. As we will see in chap­ter 17, they will improve only if both patient
and ther­a­pist appre­ci­ate the roles that these dif­fer­ent states have played in
their sur­vival.
ART, MUSIC, AND DANCE
There are thou­sands of art, music, and dance ther­a­pists who do beau­ti­ful
work with abused chil­dren, sol­diers suf­fer­ing from PTSD, incest vic­tims,
refugees, and tor­ture sur­vivors, and numer­ous accounts attest to the
effec­tive­ness of expres­sive therapies.18 How­ev­er, at this point we know
very lit­tle about how they work or about the spe­cif­ic aspects of trau­mat­ic
stress they address, and it would present an enor­mous logis­ti­cal and
finan­cial chal­lenge to do the research nec­es­sary to estab­lish their val­ue
sci­en­tif­i­cal­ly.
The capac­i­ty of art, music, and dance to cir­cum­vent the speech­less­ness
that comes with ter­ror may be one rea­son they are used as trau­ma
treat­ments in cul­tures around the world. One of the few sys­tem­at­ic stud­ies
to com­pare non­ver­bal artis­tic expres­sion with writ­ing was done by James
Pen­nebak­er and Anne Krantz, a San Fran­cis­co dance and move­ment
therapist.19 One-third of a group of six­ty-four stu­dents was asked to
dis­close a per­son­al trau­mat­ic expe­ri­ence through expres­sive body
move­ments for at least ten min­utes a day for three con­sec­u­tive days and
then to write about it for anoth­er ten min­utes. A sec­ond group danced but
did not write about their trau­ma, and a third group engaged in a rou­tine
exer­cise pro­gram. Over the three fol­low­ing months mem­bers of all groups
report­ed that they felt hap­pi­er and health­i­er. How­ev­er, only the expres­sive
move­ment group that also wrote showed objec­tive evi­dence: bet­ter phys­i­cal
health and an improved grade-point aver­age. (The study did not eval­u­ate
spe­cif­ic PTSD symp­toms.) Pen­nebak­er and Krantz con­clud­ed: “The mere
expres­sion of the trau­ma is not suf­fi­cient. Health does appear to require
trans­lat­ing expe­ri­ences into lan­guage.”
How­ev­er, we still do not know whether this conclusion—that lan­guage
is essen­tial to healing—is, in fact, always true. Writ­ing stud­ies that have
focused on PTSD symp­toms (as opposed to gen­er­al health) have been
dis­ap­point­ing. When I dis­cussed this with Pen­nebak­er, he cau­tioned me that
most writ­ing stud­ies of PTSD patients have been done in group set­tings
where par­tic­i­pants were expect­ed to share their sto­ries. He reit­er­at­ed the
point I’ve made above—that the object of writ­ing is to write to your­self, to
let your self know what you have been try­ing to avoid.
THE LIMITS OF LANGUAGE
Trau­ma over­whelms lis­ten­ers as well as speak­ers. In The Great War in
Mod­ern Mem­o­ry, his mas­ter­ful study of World War I, Paul Fussell
com­ments bril­liant­ly on the zone of silence that trau­ma cre­ates:
One of the crux­es of war … is the col­li­sion between events and
the lan­guage available—or thought appropriate—to describe
them.… Log­i­cal­ly there is no rea­son why the Eng­lish lan­guage
could not per­fect­ly well ren­der the actu­al­i­ty of … war­fare: it is
rich in terms like blood, ter­ror, agony, mad­ness, shit, cru­el­ty,
mur­der, sell-out, pain and hoax, as well as phras­es like legs blown
off, intestines gush­ing out over his hands, scream­ing all night,
bleed­ing to death from the rec­tum, and the like.… The prob­lem
was less one of “lan­guage” than of gen­til­i­ty and opti­mism.… The
real rea­son [that sol­diers fall silent] is that sol­diers have dis­cov­ered
that no one is very inter­est­ed in the bad news they have to report.
What lis­ten­er wants to be torn and shak­en when he doesn’t have to
be? We have made unspeak­able mean inde­scrib­able: it real­ly
means nasty.20
Talk­ing about painful events doesn’t nec­es­sar­i­ly estab­lish com­mu­ni­ty
—often quite the con­trary. Fam­i­lies and orga­ni­za­tions may reject mem­bers
who air the dirty laun­dry; friends and fam­i­ly can lose patience with peo­ple
who get stuck in their grief or hurt. This is one rea­son why trau­ma vic­tims
often with­draw and why their sto­ries become rote nar­ra­tives, edit­ed into a
form least like­ly to pro­voke rejec­tion.
It is an enor­mous chal­lenge to find safe places to express the pain of
trau­ma, which is why sur­vivor groups like Alco­holics Anony­mous, Adult
Chil­dren of Alco­holics, Nar­cotics Anony­mous, and oth­er sup­port groups
can be so crit­i­cal. Find­ing a respon­sive com­mu­ni­ty in which to tell your
truth makes recov­ery pos­si­ble. That is also why sur­vivors need pro­fes­sion­al
ther­a­pists who are trained to lis­ten to the ago­niz­ing details of their lives. I
recall the first time a vet­er­an told me about killing a child in Viet­nam. I had
a vivid flash­back to when I was about sev­en years old and my father told
me that a child next door had been beat­en to death by Nazi sol­diers in front
of our house for show­ing a lack of respect. My reac­tion to the veteran’s
con­fes­sion was too much to bear, and I had to end the ses­sion. That is why
ther­a­pists need to have done their own inten­sive ther­a­py, so they can take
care of them­selves and remain emo­tion­al­ly avail­able to their patients, even
when their patients’ sto­ries arouse feel­ings of rage or revul­sion.
A dif­fer­ent prob­lem aris­es when trau­ma vic­tims them­selves become
lit­er­al­ly speechless—when the lan­guage area of the brain shuts down.21 I
have seen this shut­down in the court­room in many immi­gra­tion cas­es and
also in a case brought against a per­pe­tra­tor of mass slaugh­ter in Rwan­da.
When asked to tes­ti­fy about their expe­ri­ences, vic­tims often become so
over­whelmed that they are bare­ly able to speak or are hijacked into such
pan­ic that they can’t clear­ly artic­u­late what hap­pened to them. Their
tes­ti­mo­ny is often dis­missed as being too chaot­ic, con­fused, and frag­ment­ed
to be cred­i­ble.
Oth­ers try to recount their his­to­ry in a way that keeps them from being
trig­gered. This can make them come across as eva­sive and unre­li­able
wit­ness­es. I have seen dozens of legal cas­es dis­missed because asy­lum
seek­ers were unable to give coher­ent accounts of their rea­sons for flee­ing.
I’ve also known numer­ous vet­er­ans whose claims were denied by the
Vet­er­ans Admin­is­tra­tion because they could not tell pre­cise­ly what had
hap­pened to them.
Con­fu­sion and mutism are rou­tine in ther­a­py offices: We ful­ly expect
that our patients will become over­whelmed if we keep press­ing them for the
details of their sto­ry. For that rea­son we’ve learned to “pen­du­late” our
approach to trau­ma, to use a term coined by my friend Peter Levine. We
don’t avoid con­fronting the details, but we teach our patients how to safe­ly
dip one toe in the water and then take it out again, thus approach­ing the
truth grad­u­al­ly.
We start by estab­lish­ing inner “islands of safe­ty” with­in the body.22
This means help­ing patients iden­ti­fy parts of the body, pos­tures, or
move­ments where they can ground them­selves when­ev­er they feel stuck,
ter­ri­fied, or enraged. These parts usu­al­ly lie out­side the reach of the vagus
nerve, which car­ries the mes­sages of pan­ic to the chest, abdomen, and
throat, and they can serve as allies in inte­grat­ing the trau­ma. I might ask a
patient if her hands feel okay, and if she says yes, I’ll ask her to move them,
explor­ing their light­ness and warmth and flex­i­bil­i­ty. Lat­er, if I see her chest
tight­en and her breath almost dis­ap­pear, I can stop her and ask her to focus
on her hands and move them, so that she can feel her­self as sep­a­rate from
the trau­ma. Or I might ask her to focus on her out breath and notice how she
can change it, or ask her to lift her arms up and down with each breath—a
qigong move­ment.
For some patients tap­ping acu­pres­sure points is a good anchor.23 I ask
oth­ers to feel the weight of their body in the chair or to plant their feet on
the floor. I might ask a patient who is col­laps­ing into silence to see what
hap­pens when he sits up straight. Some patients dis­cov­er their own islands
of safety—they begin to “get” that they can cre­ate body sen­sa­tions to
coun­ter­bal­ance feel­ing out of con­trol. This sets the stage for trau­ma
res­o­lu­tion: pen­du­lat­ing between states of explo­ration and safe­ty, between
lan­guage and body, between remem­ber­ing the past and feel­ing alive in the
present.
DEALING WITH REALITY
Deal­ing with trau­mat­ic mem­o­ries is, how­ev­er, just the begin­ning of
treat­ment. Numer­ous stud­ies have found that peo­ple with PTSD have more
gen­er­al prob­lems with focused atten­tion and with learn­ing new
information.24 Alexan­der McFar­lane did a sim­ple test: He asked a group of
peo­ple to name as many words begin­ning with the let­ter B as they could in
one minute. Nor­mal sub­jects aver­aged fif­teen words; those with PTSD
aver­aged three or four. Nor­mal sub­jects hes­i­tat­ed when they saw
threat­en­ing words like “blood,” “wound,” or “rape”; McFarlane’s PTSD
sub­jects react­ed just as hes­i­tant­ly to ordi­nary words like “wool,” “ice
cream,” and “bicycle.”25
After a while most peo­ple with PTSD don’t spend a great deal of time
or effort on deal­ing with the past—their prob­lem is sim­ply mak­ing it
through the day. Even trau­ma­tized patients who are mak­ing real
con­tri­bu­tions in teach­ing, busi­ness, med­i­cine, or the arts and who are
suc­cess­ful­ly rais­ing their chil­dren expend a lot more ener­gy on the every­day
tasks of liv­ing than do ordi­nary mor­tals.
Yet anoth­er pit­fall of lan­guage is the illu­sion that our think­ing can
eas­i­ly be cor­rect­ed if it doesn’t “make sense.” The “cog­ni­tive” part of
cog­ni­tive behav­ioral ther­a­py focus­es on chang­ing such “dys­func­tion­al
think­ing.” This is a top-down approach to change in which the ther­a­pist
chal­lenges or “reframes” neg­a­tive cog­ni­tions, as in “Let’s com­pare your
feel­ings that you are to blame for your rape with the actu­al facts of the
mat­ter” or “Let’s com­pare your ter­ror of dri­ving with the sta­tis­tics about
road safe­ty today.”
I’m remind­ed of the dis­traught woman who once came to our clin­ic
ask­ing for help with her two-month-old because the baby was “so self­ish.”
Would she have ben­e­fit­ed from a fact sheet on child devel­op­ment or an
expla­na­tion of the con­cept of altru­ism? Such infor­ma­tion would be unlike­ly
to help her until she gained access to the fright­ened, aban­doned parts of
herself—the parts expressed by her ter­ror of depen­dence.
There is no ques­tion trau­ma­tized peo­ple have irra­tional thoughts: “I
was to blame for being so sexy.” “The oth­er guys weren’t afraid—they’re
real men.” “I should have known bet­ter than to walk down that street.” It’s
best to treat those thoughts as cog­ni­tive flashbacks—you don’t argue with
them any more than you would argue with some­one who keeps hav­ing
visu­al flash­backs of a ter­ri­ble acci­dent. They are residues of trau­mat­ic
inci­dents: thoughts they were think­ing when, or short­ly after, the trau­mas
occurred that are reac­ti­vat­ed under stress­ful con­di­tions. A bet­ter way to
treat them is with EMDR, the sub­ject of the fol­low­ing chap­ter.
BECOMING SOME BODY
The rea­son peo­ple become over­whelmed by telling their sto­ries, and the
rea­son they have cog­ni­tive flash­backs, is that their brains have changed. As
Freud and Breuer observed, trau­ma does not sim­ply act as a releas­ing agent
for symp­toms. Rather, “the psy­chi­cal trauma—or more pre­cise­ly the
mem­o­ry of the trauma—acts like a for­eign body which long after its entry
must con­tin­ue to be regard­ed as an agent that still is at work.”26 Like a
splin­ter that caus­es an infec­tion, it is the body’s response to the for­eign
object that becomes the prob­lem more than the object itself.
Mod­ern neu­ro­science solid­ly sup­ports Freud’s notion that many of our
con­scious thoughts are com­plex ratio­nal­iza­tions for the flood of instincts,
reflex­es, motives, and deep-seat­ed mem­o­ries that emanate from the
uncon­scious. As we have seen, trau­ma inter­feres with the prop­er
func­tion­ing of brain areas that man­age and inter­pret expe­ri­ence. A robust
sense of self—one that allows a per­son to state con­fi­dent­ly, “This is what I