Recovering From Trauma and Its Obstacles

Psychoneuroimmunology and the death instinct.

Posted Mar 17, 2017

In many years of working psychotherapeutically with trauma survivors, I have learned that self-care is at the heart of trauma recovery. I have also frequently observed that highly intelligent people who are struggling with life circumstances repeatedly make bad choices for themselves that lead them into greater difficulties.  This paradox often strikes me as perplexing. Why do some smart people when dealing with traumatic life events make bad choices that are counter to self-care? Might the answer lie in our genetic programming? Or in the Greek gods?

Two years ago I attended Dr. Herbert Benson’s continuing medical education course at Harvard on resilience. Benson is the legendary father of Mind-Body Medicine, also known as complimentary medicine. At the core of Benson’s approach to managing stress is a concept he calls the relaxation response.  It is now difficult to imagine that in the 1970’s it was medical heresy to suggest as Benson did that stress contributes to health problems and that mental focusing techniques could in any way benefit the body. Fortunately, because of Benson’s work and those that followed, we now take for granted the mind-body benefits yielded by yoga, meditation, guided imagery and other such approaches. 

Benson addressed in his seminal work The Relaxation Response, Western society’s addiction to quick-fix solutions to the complex problems of human stress.  he promise of pills and gadgets has often stood in the way of a true paradigm shift that fully embraces the intricacies of the mind-body connection and the healing resources it offers. In Benson’s book Timeless Healing: The Power and Biology of Belief, he uses the analogy of the three-legged stool to demonstrate the three necessary components to maintain health and well-being in response to medical conditions. One leg is pharmaceuticals, another is surgery and procedures, and the final one is self-care. Benson views modern medical practice as being out of balance due to an over-reliance on pharmaceuticals, surgery, and procedures.  He emphasized that self-care must be embraced to balance the stool and optimize medicine, health, and well-being. 

In my work with trauma survivors, I have learned how essential the element of self-care is to recovery, as well as maintaining what has been recovered in the way of mental and physical health. There are often strong forces operating that can prevent or work against efforts to psychologically heal. These forces are both inner and outer. It is a psychological truism that as human beings we tend to resist change and instead choose to cling to the status quo. I suppose as a species this pattern has evolved as a survival measure because what is currently working to maintain homeostasis feels safe even if it is not the most effective or healthy. For example, smoking or drinking to manage stress becomes a habitual pattern for many people and while perhaps seemingly helpful in the short run can eventually lead to one’s demise. 

In deep, prolonged psychotherapeutic work with patients dealing with severe trauma, it is apparent to me that the effects of the trauma can sometimes infiltrate the entire personality and hold it hostage, kidnapped from a life fully lived. A negativistic, fearful attitude can develop that communicates life is not safe and taking risks of any kind is to be avoided at all costs.

Rather than talking solely about a diagnosis of post-traumatic stress disorder, I believe a more accurate representation is to think in terms of a spectrum of trauma-related disorders. We are increasingly learning how the brain is impacted by traumatic stress both in structure and function, affecting neuro-hormonal and neuro-behavioral regulation. Trauma affects everyone differently and it is the job of the psychotherapist to help sort out how the traumatic stress is manifesting in mood, emotions, self-concept, beliefs and interpersonal relationships.

Unraveling the impact of traumatic stress and obstacles to self-care can be far more complicated that the surface might suggest. One of the most powerful and insidious phenomenon observed in psychotherapy dates to observations and formulations documented by Sigmund Freud and the early psychoanalysts. It relates to the concept of resistance connected to psychological defense mechanisms and ways of managing anxiety. Once the patient intellectually understands the nature of their problems and potential solutions, frequently they refuse to take action or find ways to sabotage their efforts that would improve themselves or their situation. 

There is a fancy sounding psychoanalytic construct that captures this dynamic called the anti-libidinal cathexis. I love to pull this construct out of my therapeutic tool box at times of deep intrapsychic impasse. Basically, the construct says that due to the impact of trauma, the patient mistakenly believes, often unconsciously or pre-consciously, that they do not deserve to be happy, fulfilled, or even to live.  There seems to a program running that puts them on a course of self-destruction that leads ultimately to death.  It is as if a psychobiological kill switch has been activated and is stuck in the “on” position.

It becomes the difficult work of psychotherapy to detect when these kill switches are activated and to psychologically assist in their neutralization so that self-care protocols can be effectively instituted. 

Self-care can involve things as simple as maintaining a healthy diet, keeping up with supportive friends, doing regular exercise, keeping well-hydrated and getting adequate rest. But it is often the powerful forces of psychological regression that takes off-line access to employing inner and outer resources that must be dealt with. Through the power of the therapeutic alliance, and developing insight and awareness, as well as deep interpersonal support, psychotherapy helps the individual stay the regressive forces and to become fully resourced. It is indeed gratifying to see people regain, or in some cases create for the first time, a sense of self that is empowered and emboldened to go forth fully in life with a clear life purpose, and in a state of well-being and some measure of happiness

We could end our story here on a happy note, but there are darker mental elements that need to be further explored.  A neighbor in this dark realm is the concept Freud termed the death instinct or death drive. He conceptualized a dynamic interplay between the drive to life and the drive to death: Eros vs. Thanatos. We mostly only want to think about life but the truth we often do not wish to entertain is that we are in a life cycle. The death instinct or drives, Thanatos, was a concept Freud developed in his writings in the 1920’s and which was initially proposed in a work published by Sabina Spielrein. The death drive opposes Eros, the drive towards survival, propagation, and creativity

To be continued in next week’s blog.