Why I resist “grounding”: some thoughts about flashbacks and recovering from Complex PTSD
Confession: Sometimes, I like my flashbacks.
If I’m being perfectly honest, I, at the very least:
- am still attached to them
- usually have to be in one in order to write or make art, and
- sometimes even induce or consciously prolong them with drugs and environmental stimuli in order to safely stay inside them.
The right combination of music, legal stimulants, physical hunger, prescribed anxiolytics, and physical environment can work wonders.
Most people don’t know that they aren’t all horrible.
Sometimes, I am small and trailing along behind my dad on Bourbon Street or at a rodeo or a bar, with all the sensory overload and danger of being with an irresponsible and unpredictable adult in a place children shouldn’t be. These are the “good” ones.
And sometimes they are horrible, but this is sometimes just my life.
Sometimes, I am burning up on a cold night and sweating through my underwear in a corner, barely able to talk above a whisper.
Some people don’t know what they are or only get their mental models of them from movies.
For me, and for a lot of us, they don’t look like anything special:
It’s usually just another person at the party whose story you’re not privy to.byrslf.co
For me, they often look more like this:
I can’t breathe. I can’t think. I’m in flight and it’s more dangerous outside because the worst predators are cops and…medium.com
Sometimes, I am just trapped in my car, trying to meet my obligations to myself and others.
(Seriously, read those two links if you don’t know what I mean.)
Sometimes, I choose them.
I think I figured out why.
(Note: My use of the word “choose” here is predicated on you understanding that trauma responses are involuntary and that choice within them is still very limited. We’re talking a sliver here. If you don’t accept the nuance around this, please move on.)
“The challenge of trauma treatment is not only dealing with the past but, even more, enhancing the quality of day-to-day experience. One reason that traumatic memories become dominant in PTSD is that it is so difficult to feel truly alive right now. When you can’t be fully here, you go to places where you did feel alive- even if those places are filled with horror and misery.” - Bessel van der Kolk, The Body Keeps the Score, p.73
Van der Kolk’s quote explains the thing that has baffled even my trauma-specialist therapist, but that I have been ahead of her on: why I resist “grounding” so emphatically sometimes.
I dug in this spot and discovered two things.
First, I often perceive suggestions to ground as being told to shut up and suppress.
To perform masculinity.
Because those feelings make other people uncomfortable.
Because people will only like the happy/funny/witty/sexy me.
Because silence is enabling.
Because vocalizing my pain will just make me a target for further abuse.
To keep myself safe.
I remember that moment, sitting in an inpatient group psycho-ed session about stigma where I thought, and then said loud, “fuck this, when I get out of here, I’m telling everyone,” and I remember how it took me four months to the day from my diagnosis to actually come out and do that.
I did it because I have seen silence kill, because I have seen it create a new generation of victims, and I’ve decided that it ends here.
A year or so later, I was working doing HIV/STI testing and harm reduction counseling in homeless shelters when I met a man who was in the midst of a relapse after 8 years of sobriety. He had been a pillar of his recovery community, one of those “success stories” that we use to feel like maybe we can make it too and that everyone else uses to feel better about themselves for not doing anything to help. He said he’d felt things falling apart long before the evidence showed up in his social life. He said he damn well knew better and that he’d allowed it to happen. I asked what it was, what had been the reason that he’d avoided knowing what he knew. He stopped, looked down for a second, then looked me dead in the eye. “I didn’t know that it was okay to not be okay. And it almost killed me.”
I kept his gaze. I wanted to tell him that it damn near killed me, too. I couldn’t, though. So I said that thing you’re not supposed to say unless you are 100% certain that they’re reading you right: “I understand.”
Maybe it’s something peculiar to those of us who walk around with the feeling that “they” would rather see us dead than see us as people, but my decision in March of 2014 was to never be silent again.
Of course, it was not a single event, but a process that is still unfolding three and a half years later.
Of course, on a case by case basis, I have still have to do the math about the potential risks and rewards of crying out.
But, of course, silence is murderous too, and if I’m going to err then I know which side I am going to err on.
Second, I have always known this thing that good trauma therapists should know:
The top-down approach of using symptom management strategies to soothe and calm flashbacks doesn’t actually prevent them from happening in the first place. I know this may seem obvious, but you may be surprised at how few therapists explicitly acknowledge this as a part of their practice.
Trauma is something that happens in the body, and as long as the body remains unhealed then you’re going to have to keep treating symptoms until you’re dead.
(N.b. can brain/body dualism please die already?)
Borrowing from van der Kolk again, I like his metaphor of the competent rider and the unruly horse.
Each of us who have been given an unruly horse to ride have, by necessity, become competent riders. We would be dead already if we weren’t.
But what about the horse? Doesn’t it just take off bucking at awful times when everything seems to be going just fine? How predictable is it? Do you always feel like you have to have a back up plan no matter how much exercise, self-soothing, and talk therapy you do?
What happens when you have flashbacks in your sleep, and these techniques are therefore not available?
For some of us, antidepressants and mood stabilizers only make it worse.
Van der Kolk goes on:
“Many treatment approaches for traumatic stress focus on desensitizing patients to their past, with the expectation that re-exposure to their traumas will reduce emotional outbursts and flashbacks. I believe that this is based on a misunderstanding of what happens in traumatic stress. We must most of all help our patients to live fully and securely in the present. In order to do that, we need to help bring those brain structures that deserted them when they are overwhelmed by trauma back. Desensitization may make you less reactive, but if you cannot feel satisfaction in ordinary everyday things like taking a walk, cooking a meal, or playing with your kids, life will pass you by.”
So much life has passed me by, and my point is that our lives should not just be about symptom management. Yes, we tend to get really good at treating our injuries ourselves, which seems to be what the goals of CBT, DBT, and the like are… and, yes, we sure do look like rock stars sometimes with how skillfully we navigate our unruly horses, but…
Fuck that. Just fuck that.
I’m not saying that top-down approaches are not useful. Cognitive Processing Therapy, which is based on a CBT model, helped me tremendously. What I’m saying is that top down approaches should never be viewed as ends in themselves.
Maybe you think I am mischaracterizing the treatment modalities, and maybe you think I’m being unduly harsh, but I remember being at McLean Hospital’s inpatient and partial hospitalization programs thinking “Holy shit, they don’t think we ever get better. They don’t even think it’s possible.” There was a sort of stuckness that felt pervasive there, and I hated them for it. My resentment grew and grew, and I became even more symptomatic in response, but I had to hide it from them because I knew they could do little for me and yet still had the power to keep me against my will if I openly rebelled.
I really do think that, to some degree, we are actively being groomed to be lifers within a mental health system that gives lip service to holistic models but ultimately says that we need to think our way out of it.
And perhaps that conflict between what I hear in the word “grounding” and what I know it actually is taps into my most ancient experiences of seeing the life-threatening perils of silence side-by-side with my own inability to tolerate the physiological stress of the flashbacks.
I originally wrote this piece on 3/23/2016 and it sat in my email drafts, barely changed from what you see here, until today.
What surprised me most was how much I still believe what I wrote then.
What’s changed is that I am feeling worn down by the past few years and didn’t make it as far as I thought I would by now.
EMDR and body-based treatments are extremely difficult to find and insurance doesn’t want to cover them anyway. Exercise and diet help but they only do so much and are dependent on factors like income and able-bodiedness.
Look… I’m sure it’s not true for some people, but I’m going to make a blanket statement. Don’t murder me, please.
Talk therapy doesn’t fucking work for acute symptoms of complex trauma.
It’s not useless. I love my talk therapist, and it can support the stuff that does work, but it doesn’t do much on its own and recovery doesn’t happen without a rewiring of the physiology that is causing the symptoms.
I’m sorry, but I’m not saying anything that most of us who have put in years and years with it don’t already know.
And I want to say “I’m not complaining,” but the fact is that I am and there’s nothing wrong with that.
I wake up tired every single day. I know I’m having flashbacks in my sleep, even if I’m not waking up from screaming nightmares hardly ever anymore. There’s a whole history that I feel the urge to tell you about in the hope that you’ll take me seriously, but I’m going to resist it and sum up by saying: I’m maxed out doing everything I can (some of which I’ll write about soon), and I still don’t ever feel like I’m doing enough.
Still, I refuse to give in to the idea that I will never be able to sleep restfully.
I’m at the place now where I’ve accepted that I may have some symptoms for the rest of my life, but y’all…
I don’t want to be a lifer.
I don’t want to be like the doctors at the Harvard teaching hospital who don’t believe that people actually heal and urge caution I didn’t have time for.
I’ve already lost too much life.
I want my body back —
— even if, at the same time, I also don’t because the flashbacks are something of an escape from this shit and at least there I feel alive.
Maybe you’re rolling your eyes at my naivete, but I’m stuck in the dissonance and learning how to tolerate the vulnerability of presence.
I ran this piece by my dear friend Alaina Hammond before I published and she observed that “wondering how much of it is in my control, and therefore my responsibility to control, is a constant balance.”
She’s right, you know.
I’ll keep being public, I’ll keep seeing my talk therapist, I’ll keep seeking out other modalities in concerted bursts and spurts and sputters, and I’ll keep choosing flashbacks less and less frequently, but van der Kolk was right and we still have to live anyway.
I founded and direct Other Lives, an intersectional peer-led trauma survivors’ network and advocacy organization.