Trauma & Art

My good people, don’t forget: go and tell,

My good people, write it down!  

(Simon Doubnow, cited in Gautier & Sabatini Scalmati, 2012)

Art making provides the opportunity of expression, recording and reflection. Also, through the creation of art one may often be exposed to material before he/she can fully make sense of what has surfaced. As one is ready to deal with more aspects of the memory, traumatic event or abuse, clarity is increased and deeper understanding is reached. I know from personal experience that returning to drawings or written material, in retrospect, yields further and deeper awareness and insight and allows one to understand and make important links across time and places, and thus, make new meaning of experiences. Furthermore, survivors develop an absence of a continuous thread of memory and my ‘art journal’ or drawings have become a kind of thread that connects the parts of me, who suffered the pain, but also the related emotions and the actual events across time; a visual thread that ties parts of my life story together. Engaging in this long art journal, which has by now become an art project, has provided a stronger sense of continuity among events, places and people and has assisted me in reconstructing my trauma story and creating new meaning of experiences, which according to Herman, is a fundamental stage of recovery (Herman, 1997).  Reconstruction transforms the traumatic memories because through processing and reprocessing the different aspects and fragments of memories become integrated and one’s life story becomes more coherent. The process of reconstruction also allows us to focus on the parts of our story that show our abilities and strengths, as well as our wounds, and we are able to create a more empowered storyline and become ‘committed to stop replaying the destructive messages of the past which render us powerless’ (Van Loon and Kralik, 2005).  Furthermore, reconstructing one’s story is an important part of healing because it facilitates change and allows us to incorporate, as part of our self, aspects of this new changing more powerful self that will not hold us back during the transition that takes place during healing and recovery.

Moreover, although survivors might be aware of gaps in their memory or capacity to dissociate painful experiences and although they may not remember long stretches of their childhood, they often find it difficult to explore the reason, because it is often very scary and painful to bring, to conscious awareness, what one has struggled to keep out of sight in order to survive. Exploring the causes behind this lack of continuity in memory would force one to face what one has through natural defensive mechanisms buried out of sight.Unfortunately, resorting to defensive mechanisms often means that the abuse and victimization is often continued in adulthood. However, because our sense of self is construed around our life history, ‘loss of memory or gaps in our personal history, are often perceived as an assault on our sense of self and identity’ Steinberg and Schnall (2003). Continuity allows one to make connections and attach meaning to events, which enhances safety and freedom from past traumatic experiences and victimization in the present. But, reconstruction of one’s story does not only require remembering and breaking the barriers of amnesia, but the more difficult task of ‘coming face to face with the horrors of the other side of the amnesiac barrier and releasing these experiences into a fully developed life narrative’ (Herman, 1997). This process can be long and ongoing and often requires making sense of the countless fragmented and frozen images, flashbacks, bodily sensations, physical symptoms and emotions, all parts of memories waiting to be connected and integrated. It may involve dealing with related painful and unwanted emotions and working with bodily sensations and physical symptoms, but ‘we have the innate capacity to heal not only ourselves, but our world, from the debilitating effects of trauma’, which ‘need not be a life sentence because with the right resources, support and knowledge trauma can be transformative’ (Levine, 1997). It also involves placing experiences in temporal and spatial context, in order to be able to create new meaning of experience and a more coherent life narrative, as well as, increasing safety and freedom in the ‘here and now’. It involves relearning and unlearning, but fortunately, the human brain is ‘malleable, programmable and reprogrammable and highly responsive to influences’ (Rothschild, 2000), Complex PTSD symptoms can be healed or can be dealt with and survivors are proof of the extraordinary human mind ‘both to defend itself against inhumanity and to recover from the wounds sustained in that life or death battle (Steinberg and Schnall, 2003). This process of experiencing and integrating the feelings, the thoughts, the bodily sensations, the pain or other types of physical discomfort, the images, the smells and the sounds of each memory and trying to place the memory, event or group of experiences in context can also help survivors diffuse triggers and cues by understanding why people, objects, smells, activities, dates, songs, places (literally anything) can trigger discomfort, emotions or physical symptoms and sensations. Through processing memories and life experiences and releasing dissociated fear and anger constructively survivors can understand why certain stimuli can trigger fear, anxiety, anger, despair, dysfunction, fatigue, physical pain or disease processes, simply because they are reminders of the traumatic event or even worse because they have intentionally been paired with pain and threats by the perpetrators to ensure silence and secrecy. By staying with the sensations or emotions that surface we can often understand which particular triggers or cues have caused the discomfort or distress and then by engaging in deeper memory and body work we can explore the associated memories, bodily sensations and emotions, in order to decrease symptoms, physical pain or anxiety that is connected to the abuse, and thus, gradually bring about deeper healing, understanding and freedom from our past and perpetrators.

Additionally, the process of creating a new life narrative requires one to reframe and often view family members, friends and others through a totally different perspective, which is not easy. However, by being able, through integration and healing, to consciously reframe the perpetrators and abusers survivors ‘are actively disarming their perpetrators’ authority over their life and reclaiming the territory of their life’ (Van Loon and Kralik, 2005).  Furthermore, the process of making new meaning of one’s experience allows one to let go of painful material and reach the kind of closure suitable for each survivor. Through shedding our denial, integrating dissociated aspects of the self and dissociated experiences, and through empowerment and new understanding, we can let go and move on.Finally, by creating a new life narrative we can at last break the silence and tell our story. We can narrate our story though writing, creating art and music and speaking. Anna Sabatini Scalmati and Andres Gautier (2012) write ‘narration is the realm for standing up to the vicious circle that would seal their lips, so that the social environment that does not care to know them, does not extinguish their desire to be known and they themselves do not regulate self-expression to the sphere of psychosomatic symptoms and mental illnesses’.

 References

Gautier, A. & Sabatini Scalmati, A. (2012) Bearing Witness: Psychoanalytic Work with People Traumatized by Torture and State Violence, Karnac, Great Britain

Herman, J. (1997) Trauma and Recovery: the Aftermath of Violence-from Domestic Abuse to Political Terror, Basic Books, New York

Levine, P. (1997), Waking the Tiger: Healing Trauma,

Steinberg, M. and Schnall, M. (2003) The Stranger In The Mirror: Dissociation-The Hidden Epidemic, Quill, New York

 Van Loon, A. & Kralik, D. (2005) Reclaiming Myself after Child Sexual Abuse, Australia

Trespassing  or  Entitled and Lawless

When trauma occurs it first impacts the autonomic nervous system and elicits dysregulated arousal. Our frontal lobes shut down and our reactions are subcortical, in other words, when faced with trauma our instinctual/ physical defences are automatically engaged. Fighting and fleeing are active defensive responses, but often they threaten survival, and therefore, they may be replaced by more passive responses like submission and freezing, which over time contribute to trauma symptoms. As a result, becausetraumatic events cannot be experienced reflectively or regulated by thought, traumatic experiences remain unintegrated with emotions and meaning of the trauma and they manifest in the form of embodied PTSD. There are many therapists and researchers in the field now that believe that a lot of trauma and dissociative symptoms are physical and are stored in the body when there is no outlet to the experience. Also, many symptoms may represent particular physical traumas. Pat Ogden suggests that trauma survivors have dysregulated nervous systems and unresolved animal responses and that trauma has more to do with somatic aspects. As already mentioned, trauma responses are instincts (subcortical), and in PTSD these subcortical responses take over because they began and were not completed. If these natural, involuntary reactions are not integrated with emotions and the meaning making of the traumatic experience, the trauma manifests as PTSD symptomatology. Ogden and Minton (2000) suggest that during a traumatic event a resolution of responses might be accomplished by fighting or fleeing; however, for most traumatised individuals this does not occur and they are plagued by the return of incomplete or ineffective sensorimotor reactions in such forms as intrusive images, sounds, smells, body sensations, physical pain, constriction, numbing and the inability to modulate arousal.

Moreover, if trauma is complex and prolonged it manifests in complex PTSD and dissociative disorders. Onno van der Hart views DID as the most complex form of PTSD and PTSD the least complex dissociative condition or disorder. Both PTSD and complex PTSD involve dissociation on a continuum. Over the last years, the integration of psychology with biology and advances in neuroscience and developmental and attachment theory, has allowed an expansion of knowledge and has led to a greater understanding of natural defences to trauma, especially, dissociation, which evolves out of our early relationships with our caregivers, which impact the development of the right brain (Allan Schore). Dissociation is a deep survival strategy, which allows detachment from unbearable situations – ‘escape when there is no escape’– but compromises trauma survivors’ ability to integrate experience (Allan Schore). It means survival and it provides a miraculous solution initially, but fires back, preventing growth and freedom in adulthood because it ‘becomes rigidity and it becomes dysfunctional’ (Dan Siegel). Dissociation becomes a stress coping regulatory strategy, which creates a lot of problems for survivors in adulthood and actually often opens the door to further victimization and abuse. Allan Schore believes it is not so much the trauma that is a limiting factor as the defenses against it. Therefore, it is important for therapy to focus on the alteration of stress coping strategies like dissociation and affect dysregulation. Dan Siegel refers to dissociation as the capacity for divided attention, which he distinguishes from the freeze response. Moreover, both hyperarousal and hypoarousal can lead to dissociation. In hyperarousal, dissociation can occur because the intensity and accelerated pace of sensations and emotions overwhelm one’s cognitive processing so the person cannot stay present with the traumatic experience, whereas, in hypoarousal, it may manifest as reduced capacity to feel or sense events and one may experience a sense of leaving the body. Dan Siegel claims that trauma disrupts the flow of energy and information, which are fundamental components of a healthy state of mind. It impairs integration of the mind, which is the linkage between differentiated parts and which is the basis of affect, attention and behaviour integration (Dan Siegel). Allan Schore suggests that dissociation is a lack of integration within the right hemisphere of the brain. Additionally, Onno van der Hart claims that we are born with an innate integrative capacity, but severe trauma impacts this capacity and that during trauma the mind breaks or falls apart into different parts/ subsystems, which are stuck in ‘trauma time’ and which when triggered can re-enact or relive the trauma. Finally, Onno van der Hart also views dissociation as an underlying organisation of symptoms instead of merely one symptom of traumatisation and believes that dissociation is the key concept to understanding traumatization. He also believes that chronic child abuse and severe forms of traumatisation involve greater levels of dissociative symptoms (Onno van der Hart).

Trauma in childhood impacts our development and future well-being and influences what we become and how much of our potential we will be able to realise. Early and/or prolonged repeated trauma does not only cause difficulty in regulating emotions, variations in consciousness (dissociation, depersonalisation) and changes in sense of self, but also causes loss of intimacy, distrust, somatisation and immune system depletion, loss of sustaining faith, avoidance and numbness, addictions, etc. Dan Siegel discusses trauma from a developmental context and suggests that traumatic experiences become embedded in the frame of the developing mind, which compromises how a person will respond developmentally. More specifically, Allan Schore claims that the evolution of attachment theory has reached a point of interpersonal neurobiology and we now know that early trauma leaves an imprint on the right brain, where traumatic memories are stored. Abuse, neglect, maltreatment from our primary caregivers impacts the early developing right brain, and therefore, there is emphasis on the importance of the early attachment and the development model when treating trauma.Allan Schore claims that we now know that dissociation evolves out of early attachment relations, which directly impact the early right brain where stress regulation occurs. Moreover, chronic exposure to cortisol will change synapses and dendrites in hippocampus and smaller hippocampal and amygdale volume has been reported in conditions like PTSD, DID and other disorders linked to child abuse. As a result of these discoveries or re-discoveries in the field over the last years 15 years or so, there has been a paradigm shift from cognitive and behavioural theories into an emotional psychobiological theory of trauma. This shift has resulted in neuroscience validating the unconscious in everyday life and the centrality of emotional process. There has been a shift from explicit left brain processes to implicit, unconscious psychobiological processes linked to the early developing right brain. This has brought about a shift in understanding defences to trauma and dissociation and dissociated affect and how these can be worked out clinically. Intense fear and other difficult feelings can be in the body and can be dissociated. This centrality of dissociated emotions involved in trauma is also showing that insight psychotherapeutic driven models and simple talk therapy are not adequate because research studies have shown that when the stress is greater it moves from the left brain to the right brain (Allan Schore). Therefore, in order to heal and overcome, we need to access the subcortical parts of the brain and reach a deeper understanding of our psychological core in order to decrease dissociation and affect dysregulation and to allow our coping defenses to become more complex and mature. In other words, deeper healing allows us to increase our tolerance of stress, decrease our tendency to dissociate and generally cope with anxiety/fear in more positive ways. CBT models which rely on left brain processes work towards inhibiting and controlling emotional processes, not regulating emotions (both conscious and unconscious) and they further put emphasis on symptom reduction not deeper growth and development, which would require restructuring of the unconscious  (restructuring the right brain). Actually, over dependence on the left brain may result in lack of reflective capacity and left brain processing may interfere with healing, and moreover, it often constructs a convenient life narrative.So encouraging the expression and processing of dysregulated and dissociated affects (feelings) and helping trauma survivors re-experience tolerable doses of trauma in a safe environment is necessary in facilitating healing. Neuroscientists have found that the right brain, which stores implicit memory and survival defences like dissociation (not only the trauma but the defences against it), is dominant for the processing of unconscious self-images, as well, which can often be contradictory to the conscious sense of self. It is also suggested that the plasticity of the brain lies more in the non-conscious parts of the brain (Allan Schore).

 (Tonya Alexandri – March 2014)

Sources and bibliography

Allan Schore’s articles in the Articles-Essays part of this website  

Pat Ogden and Kekuni Minton’s article in the Articles-Essays part of this website

The Haunted Self: Structural Dissociation and the Treatment of Chronic Traumatization by Onno van der Hart, Ellert Nijenhuis and Kathy Steele

Siegel, Daniel J. Pocket Guide to Interpersonal Neurobiology: An Integrative Handbook of the Mind by Daniel J. Siegel