PROLOGUE: FACING TRAUMA

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.

O
PROLOGUE
FACING TRAUMA
ne does not have be a com­bat sol­dier, or vis­it a refugee camp in Syr­ia
or the Con­go to encounter trau­ma. Trau­ma hap­pens to us, our friends,
our fam­i­lies, and our neigh­bors. Research by the Cen­ters for Dis­ease
Con­trol and Pre­ven­tion has shown that one in five Amer­i­cans was sex­u­al­ly
molest­ed as a child; one in four was beat­en by a par­ent to the point of a
mark being left on their body; and one in three cou­ples engages in phys­i­cal
vio­lence. A quar­ter of us grew up with alco­holic rel­a­tives, and one out of
eight wit­nessed their moth­er being beat­en or hit.1
As human beings we belong to an extreme­ly resilient species. Since
time immemo­r­i­al we have rebound­ed from our relent­less wars, count­less
dis­as­ters (both nat­ur­al and man-made), and the vio­lence and betray­al in our
own lives. But trau­mat­ic expe­ri­ences do leave traces, whether on a large
scale (on our his­to­ries and cul­tures) or close to home, on our fam­i­lies, with
dark secrets being imper­cep­ti­bly passed down through gen­er­a­tions. They
also leave traces on our minds and emo­tions, on our capac­i­ty for joy and
inti­ma­cy, and even on our biol­o­gy and immune sys­tems.
Trau­ma affects not only those who are direct­ly exposed to it, but also
those around them. Sol­diers return­ing home from com­bat may fright­en their
fam­i­lies with their rages and emo­tion­al absence. The wives of men who
suf­fer from PTSD tend to become depressed, and the chil­dren of depressed
moth­ers are at risk of grow­ing up inse­cure and anx­ious. Hav­ing been
exposed to fam­i­ly vio­lence as a child often makes it dif­fi­cult to estab­lish
sta­ble, trust­ing rela­tion­ships as an adult.
Trau­ma, by def­i­n­i­tion, is unbear­able and intol­er­a­ble. Most rape vic­tims,
com­bat sol­diers, and chil­dren who have been molest­ed become so upset
when they think about what they expe­ri­enced that they try to push it out of
their minds, try­ing to act as if noth­ing hap­pened, and move on. It takes
tremen­dous ener­gy to keep func­tion­ing while car­ry­ing the mem­o­ry of ter­ror,
and the shame of utter weak­ness and vul­ner­a­bil­i­ty.
While we all want to move beyond trau­ma, the part of our brain that is
devot­ed to ensur­ing our sur­vival (deep below our ratio­nal brain) is not very
good at denial. Long after a trau­mat­ic expe­ri­ence is over, it may be
reac­ti­vat­ed at the slight­est hint of dan­ger and mobi­lize dis­turbed brain
cir­cuits and secrete mas­sive amounts of stress hor­mones. This pre­cip­i­tates
unpleas­ant emo­tions intense phys­i­cal sen­sa­tions, and impul­sive and
aggres­sive actions. These post­trau­mat­ic reac­tions feel incom­pre­hen­si­ble
and over­whelm­ing. Feel­ing out of con­trol, sur­vivors of trau­ma often begin
to fear that they are dam­aged to the core and beyond redemp­tion.
• • •
The first time I remem­ber being drawn to study med­i­cine was at a sum­mer
camp when I was about four­teen years old. My cousin Michael kept me up
all night explain­ing the intri­ca­cies of how kid­neys work, how they secrete
the body’s waste mate­ri­als and then reab­sorb the chem­i­cals that keep the
sys­tem in bal­ance. I was riv­et­ed by his account of the mirac­u­lous way the
body func­tions. Lat­er, dur­ing every stage of my med­ical train­ing, whether I
was study­ing surgery, car­di­ol­o­gy, or pedi­atrics, it was obvi­ous to me that
the key to heal­ing was under­stand­ing how the human organ­ism works.
When I began my psy­chi­a­try rota­tion, how­ev­er, I was struck by the con­trast
between the incred­i­ble com­plex­i­ty of the mind and the ways that we human
beings are con­nect­ed and attached to one anoth­er, and how lit­tle
psy­chi­a­trists knew about the ori­gins of the prob­lems they were treat­ing.
Would it be pos­si­ble one day to know as much about brains, minds, and
love as we do about the oth­er sys­tems that make up our organ­ism?
We are obvi­ous­ly still years from attain­ing that sort of detailed
under­stand­ing, but the birth of three new branch­es of sci­ence has led to an
explo­sion of knowl­edge about the effects of psy­cho­log­i­cal trau­ma, abuse,
and neglect. Those new dis­ci­plines are neu­ro­science, the study of how the
brain sup­ports men­tal process­es; devel­op­men­tal psy­chopathol­o­gy, the study
of the impact of adverse expe­ri­ences on the devel­op­ment of mind and brain;
and inter­per­son­al neu­ro­bi­ol­o­gy, the study of how our behav­ior influ­ences
the emo­tions, biol­o­gy, and mind-sets of those around us.
Research from these new dis­ci­plines has revealed that trau­ma pro­duces
actu­al phys­i­o­log­i­cal changes, includ­ing a recal­i­bra­tion of the brain’s alarm
sys­tem, an increase in stress hor­mone activ­i­ty, and alter­ations in the sys­tem
that fil­ters rel­e­vant infor­ma­tion from irrel­e­vant. We now know that trau­ma
com­pro­mis­es the brain area that com­mu­ni­cates the phys­i­cal, embod­ied
feel­ing of being alive. These changes explain why trau­ma­tized indi­vid­u­als
become hyper­vig­i­lant to threat at the expense of spon­ta­neous­ly engag­ing in
their day-to-day lives. They also help us under­stand why trau­ma­tized
peo­ple so often keep repeat­ing the same prob­lems and have such trou­ble
learn­ing from expe­ri­ence. We now know that their behav­iors are not the
result of moral fail­ings or signs of lack of willpow­er or bad character—they
are caused by actu­al changes in the brain.
This vast increase in our knowl­edge about the basic process­es that
under­lie trau­ma has also opened up new pos­si­bil­i­ties to pal­li­ate or even
reverse the dam­age. We can now devel­op meth­ods and expe­ri­ences that
uti­lize the brain’s own nat­ur­al neu­ro­plas­tic­i­ty to help sur­vivors feel ful­ly
alive in the present and move on with their lives. There are fun­da­men­tal­ly
three avenues: 1) top down, by talk­ing, (re-) con­nect­ing with oth­ers, and
allow­ing our­selves to know and under­stand what is going on with us, while
pro­cess­ing the mem­o­ries of the trau­ma; 2) by tak­ing med­i­cines that shut
down inap­pro­pri­ate alarm reac­tions, or by uti­liz­ing oth­er tech­nolo­gies that
change the way the brain orga­nizes infor­ma­tion, and 3) bot­tom up: by
allow­ing the body to have expe­ri­ences that deeply and vis­cer­al­ly con­tra­dict
the help­less­ness, rage, or col­lapse that result from trau­ma. Which one of
these is best for any par­tic­u­lar sur­vivor is an empir­i­cal ques­tion. Most
peo­ple I have worked with require a com­bi­na­tion.
This has been my life’s work. In this effort I have been sup­port­ed by
my col­leagues and stu­dents at the Trau­ma Cen­ter, which I found­ed thir­ty
years ago. Togeth­er we have treat­ed thou­sands of trau­ma­tized chil­dren and
adults: vic­tims of child abuse, nat­ur­al dis­as­ters, wars, acci­dents, and human
traf­fick­ing; peo­ple who have suf­fered assaults by inti­mates and strangers.
We have a long tra­di­tion of dis­cussing all our patients in great depth at