I Aced the Test! Part 4: Know thy enemy

I promised we’d take a look at the consequences of long-term stress (and, by association, trauma) on the body, didn’t I? That’s today’s topic so buckle up, Class.

Before I jump in, I want to define a few terms so we’re all speaking the same language.

The amygdala is a little almond-shaped cluster that controls your emotions–namely, fear and the fight/flight/freeze response. Memory and decision-making are also controlled by the amygdala.

The autonomic nervous system controls all unconscious processes, like breathing, blood pressure, and heart rate. Think of it like a car with automatic transmission, or being on autopilot.

Adrenal glands produce adrenaline and cortisol when the body reacts to a stressor. The inner medulla is the part that produces the hormones epinephrine and norepinephrine, which help kick off the whole fight-or-flight response.

In a nutshell:

Stressors trigger the sympathetic nervous system and hormones come rushing in full-bore. The amygdala enters the chat, which sets off a chain reaction with the adrenal glands and other endocrine systems. Your blood pressure goes up, your heart rate increases, you sweat. Without you even noticing it, your body is preparing to take one of three paths: fight, flight, or freeze.

When in crisis, our bodies and minds work in tandem to respond to the situation. The good old autonomic nervous system kicks into gear, triggering an immune response (which is designed to protect the body and fight off “intruders,” so to speak)¹. This immune response releases histamines, which are also the cause of hay fever symptoms like itchy eyes and hives. It may sound counterintuitive, but all of these unpleasant symptoms are part of your body’s fight to keep you alive. The second the stress hit that tiny little amygdala, you were no longer in the driver’s seat. Ever since that moment, you’ve been on autopilot–think of your body as a kind of gundam suit designed to protect you by any means necessary. This response is as effortless and natural as breathing. 

When most people hear the word “adrenaline,” they often imagine a scene such as a mother lifting a car off her baby. Our entire autonomic nervous system is wired to keep us alive, and the body can do incredible things when under acute stress. 

However, you can’t sustain that level of intensity forever. Think of a rubber band. You can only stretch it so much before it begins to lose some of its elasticity, and the same principle applies to stress and the body. Our bodies are not built to sprint at 84,000 miles per hour 24 hours a day, 8 days a week, and that’s precisely what long-term stress demands of you. 

Miller, Chen, and Parker (2010) describe stress as something that “accumulates” in the body’s cells. What this means for you, dear Reader, is that your body is in a constant state of inflammation because those hormones are poppin’. Even if it’s more of a wallflower than the life of the party, that inflammation is still there. 

This leads us to our next point: vulnerability for chronic illness. When your body is constantly on high-alert, it reacts to stimuli that may not bother the average bear. Many trauma survivors have at least one, if not multiple, chronic health conditions. Autoimmune disorders such as lupus are more common in adult cis female trauma survivors². Additionally, the odds of an autoimmune disorder causing an individual’s first hospitalization were higher among adults who reported two or three different types of childhood adversity, such as physical, sexual, and/or verbal abuse; parental neglect; or having a parent or caregiver who struggles with substance abuse or mental illness³. 

There is a strong behavioral component to this complex issue as well. Early trauma leads to hypervigilance and mistrust, meaning there are cognitive and emotional factors layered on top of the biological aspect. (It’s like the world’s worst sandwich, basically.)

Let’s pause for a visual aid. I wonder how many of you are familiar with our good friend Ouroboros. 

Picture the biological factors as the head of the snake, and the cognitive/emotional factors as the tail. Or reverse it. Either way, they are simultaneously feeding and devouring each other. Much like our old pal Anxiety, stress feeds itself. 

So, that probably sounds terrifying, right? It doesn’t have to be. Here are some platitudes to explain why:

• Knowledge is power.
• Know thy enemy.
• If it bleeds, we can kill it.

If we know what our own vulnerability factors are, we can find ways to counter them. If you have a chronic illness, make sure you’re keeping in touch with your doctor and taking any medications you’re prescribed. Try to eat well, stay hydrated, get enough sleep. Take at least a minutes throughout the day to do something you enjoy and celebrate being alive. A client once very astutely described living (versus surviving) as “nurturing the being as well as the human.” We exist on many levels–physical, emotional, cognitive, spiritual. Please be kind to yourselves and send love into the darkness.

One final note:

Take care of yourselves, Readers. Go take a safe, socially distant rainbow walk. Get some vitamin D–it’s good for you! Read a book. Plant a tree. Take a hot shower with a frozen orange. Meditate. And for the love of god, wear a mask and stop touching your face.

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1 Quas, J. A., Bauer, A., & Boyce, W. T. (2004). Physiological reactivity, social support, and memory in early childhood. Child Development, 75(3), 797-814.

2. Roberts AL, Malspeis S, Kubzansky LD, et al. Association of trauma and post-traumatic stress disorder with incident systemic lupus erythematosus in a longitudinal cohort of women. Arthritis Rheumatol. 2017 Nov;69(11):2162–2169.

3. Miller, G. E., Chen, E, & Parker, K.J. (2011). Physiological stress in childhood and susceptibility to the chronic diseases of aging: Moving toward a mdoel of behavioral and biological mechanisms. Psychological Bulletin,137(6), 959-997.

I Aced the Test! Part 3: The COWs are out to pasture

Disclaimer: Growing up in the Midwest, I never encountered any actual stories/incidents of cow-tipping. But my god, I wish I had.

In 1959, Carl Rogers coined the acronym “COWs,” or Conditions of Worth. According to the man himself:

“The self-structure is characterized by a condition of worth when a self-experience or set of related self-experiences is either avoided or sought solely because the individual discriminates it as being less or more worthy of self-regard. … A condition of worth arises when the positive regard of a significant other is conditional, when the individual feels that in some respects he is prized and in others not. Gradually this same attitude is assimilated into his own self-regard complex, and he values an experience positively or negatively solely because of these conditions of worth which he has taken over from others, not because the experience enhances or fails to enhance his organism.” *

TL;DR: We crave unconditional positive regard from our caregivers pretty much from the get-go (example: “I will love you no matter what”). Unfortunately, a lot of times, you end up with a child receiving the message (whether overtly or through subtext) “I love you if/when you ___” and/or “You’re bad/undeserving of love/etc. if you [insert thing that caregiver/person of influence has determined is bad].”

That’s radically different than the message of “I love you, you’re safe, I’ll take care of you” that we instinctively need. Again, the pleasure principle applies: We’re hardwired to gravitate toward what feels good and avoid what feels bad. 

Ironically, it’s the uncomfortable things that stick in our minds. Think about a time you received a critique at work or got into a fight with a loved one. When you think about that day, what do you remember most–the critique/fight or everything else you did within that 24-hour span?

That negative little voice in your head–whose is it? A parent? A friend? A romantic partner? …

Yourself?

This is where core beliefs come into play, but that is an entirely different discussion for another day. In the meantime, take a look at this worksheet for more info on core beliefs and how to identify yours.

This is one of the reasons why those pesky ACEs are so persistent, even years later. We may be designed to move toward the comfortable, toward stasis, and yet we’re awesome at making ourselves miserable.

The next post in this series will focus on the biology of chronic stress and how ACEs can be a risk factor for certain illnesses. In the meantime, readers, take a moment to reflect on the following questions about your own inner monologue/critic. 

 

* Rogers C (1959) ‘A Theory of Therapy, Personality, and Interpersonal Relationships, As Developed in the Client-Centered Framework’, in Koch S (ed) (1959)

I aced the quiz! Part Two: That face.

Okay, so now that we know what ACEs are, let’s get a little more personal.

To begin, I’d like to share with you two pictures from my childhood.

1993, age four

1994, age five – kindergarten photo

Are these the same child?

Yes.

In the photo on the left, I am dolled up and mugging for the camera. I’m not sure who took me to get my photo taken that day (probably at Sears). If it was my biological mother, she was having an exceptionally good day. The reality is that one of my aunts probably arranged the whole thing. But I look happy, round-cheeked, grinning at the camera with a twinkle in my eyes.

In the photo on the right, taken roughly a year and change after the first, I am posing for my kindergarten photo. I was grumpy partly because of that damn cowlick, but also because my home life had basically gone to hell in a handbasket in the space of a year. My mother was drinking again, heavily. She would often leave me alone in the house at night to go out to bars. One of my earliest memories is waking up alone and wandering through the darkened house. I walked outside and paced the sidewalks for what felt like hours, watching as the lights in the houses lining the street flickered off, one by one by one.

Readers, that is the loneliest I have ever felt in my life.

If we ignore the backstory and focus only on the images (lighting and photo quality aside), what remains is this: The girl on the right has lost all the baby fat from her cheeks. Her eyes are huge, dark, and sunken. She is trying to smile but her teeth are gritted. She does not look at the camera, but rather past it, as if trying to see something in the distance. You know, that old chestnut–the Thousand Yard Stare.  Still a cute kid, but not the type of child you’d look at and go, “Oh, yeah, she’s doing well.”

Chronic stress changes the body in a myriad of different ways. I’ll touch on the biology of chronic stress (behavioral medicine is a fascination of mine) in the next post, but for now, let’s focus on face.

They say the eyes are the windows to the soul. If we peeked through your windows, what might we find? I’m looking forward to hearing from you, readers!

I aced the quiz! Part One: Know thy enemy.

Disclaimer: The information contained in this post is not intended to diagnose or treat any condition. I am a licensed therapist, but I am not your therapist. 

I ACEd the quiz! Tongue firmly in cheek, of course. There is no quiz, but today I would like to touch on trauma and its physical effects–hence the reference to ACES, or the Adverse Childhood Experiences Scale.

As any even casual reader of the blog knows, trauma is kind of My Jam. I love working with clients who are struggling with the same core issues I struggled with the first 20+ years of my life. I knew that was going to be bailiwick from the time I started therapy myself, at 18, but I didn’t really do much with it until I entered grad school and suddenly had to write a thousand different papers (that were not centered around arguing whether the box of money in Faulkner’s The Sound and the Fury is actually a box of shit. Look it up. It’ll change your life).

When I got my very first assignment, my brain went “PING!” and told me trauma was the area to hit. It’s a touchy area, for sure. Go too fast, and you risk re-traumatizing your client and damaging rapport. Go too slowly, and your client will stagnate. It’s like a dance.

The ACES study began in an obesity clinic in 1985, believe it or not. Physicians were interested in figuring out why people kept dropping out of their weight loss program; long story short, they developed the Adverse Childhood Experiences Scale and administered it to their patients. The results were unprecedented: they uncovered a link between childhood trauma and struggles with controlling their weight later in life. 

I’d love to wax poetic about the biology of chronic stress and implications for adulthood, but that needs its own post.

On to the significance of ACEs. The instrument itself is simple–ten self-report items, scored either “0” or “1.” I’ve re-typed it here for the sake of your eyes, but you can see the original and lots of great info on acestoohigh.com.

To avoid inadvertently triggering readers, I’m going to put the actual scale underneath this spoiler tag, as the questions do involve all forms of child abuse.

On Vulnerability

There are so many words in the English language relating to innocence and vulnerability, and most of them can bring me way down if I’m not careful. They provoke some ancient anxiety that I’ve come to realize, with the help of my excellent therapist, are linked to what she calls my “wounded younger self.” (I was incredibly skeptical of inner child work at first, but it is incredibly effective and incredibly healing.)

“Little” is an adjective that, when paired with certain words that also remind me of innocence, usually messes me up emotionally. That’s the word that got under my skin tonight.

I’ve been feeling kind of “off” the last few days. I recently blocked my mother completely on my phone–including the second number I thought she’d deleted until she used it to contact me after I blocked the first number–and was treated to some really unsettling dreams on Monday and Tuesday night.

Monday’s main feature involved me skipping my grandmother’s birthday party because my mother was going to be there and I knew she’d be drunk. Tuesday’s late-night horror show involved a healthy helping of guilt because I was hiding from her (in a Target, of all places) while she wailed and lamented that she “couldn’t believe [I] didn’t want to talk to her.”

Naturally, this put me in a pretty weird headspace today. Wednesdays are my big clinical days and I do group as well as individual client work. As such, I generally store my feelings away to deal with later and do a pretty good job of not thinking about them at all during the day because I’m 100% focused on my clients. (Side note: I adore them, and I’m bummed that I’m leaving my practicum site in a few weeks!)

On the drive home from class this evening, though, those neglected feelings reared their ugly collective heads and roared.

The anxiety and guilt were so powerful that I considered just going to bed early and sleeping it off.

Instead, I took a shower.

I focused hard on those thoughts and attempted to get a good, cathartic cry in. Nothing happened.

I turned the focus to that wounded younger self I mentioned and took the opportunity to literally hug myself while I waited for the conditioner to work its magic on my decidedly unruly hair. I decided to speak aloud because I’m home alone most days during the week and hey, I knew the cat wouldn’t judge me. (Audibly, anyway.)

I told my younger self that it’s okay. I told her I love her and that I’m sorry she felt like no one could keep her safe. I told her that I’m going to do it. This changed into me speaking to whatever hypothetical future child I’ll end up having. I promised that child to take the best care of it I can and to make sure it never feels afraid or lonely.

And I cried. Instead of stifling it or trying to be tough, I gave myself over to it completely–ugly, wracking sobs. After a while, those sobs turned into relieved laughter that I’m sure sounded like I’d finally gone completely ’round the bend.

I think there’s something to be said for having a good cry.

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On Monday, I spoke to my clients in group about the concept of “ghosts”–they had all shared some intense and profound stories about their deepest wounds, their secret shames, their most painful memories. I told them that while they can haunt you, they can’t physically hurt you. You can start to let go of them.

I led them in one of my new favorite exercises, which is “HA!” breathing. Basically, you take a deep breath and push that breath out while making a “HA!” sound. I opened the group with the exercise and invited them to imagine themselves yelling at someone or letting frustration out. I demonstrated (because I am not afraid to look silly anymore), and they loved it. After the big, intense sharing session, I led them in the exercise again, this time instructing them to imagine the “HA!” on the exhale as them blowing out part of their ghosts.

I’m glad it was a hit, and I encourage you all to try it, readers. Howling into the void or, as I called it, “therapeutic yelling,” is incredibly cathartic.

 

Dichotomy

Is it possible to simultaneously be the most troubled and the most well-adjusted person you know? The deeper I go into my counseling program, the more this question pops into my mind. On the one hand, my demons are legion. On the other, I keep them very well-controlled and they all have little color-coordinated leashes.

Am I well-adjusted because I have to be? Does being well-adjusted look the same, or mean the same thing, for people who have backbreaking loads of trauma and those who don’t?

I used to worry a lot about whether my personal mental health history meant that I can’t be a therapist. I still worry about that, though thankfully not as much. Tonight in class, we were discussing self-disclosure and one of my classmates brought up that exact question–how are our clients supposed to trust us if they know we have our own set of problems?

I guess it’s one of those situations where what you have doesn’t matter as much as how you handle it. I get up every day and even though I do a fair amount of yelling at the intrusive negative thoughts, I still manage to accomplish everything on my to-do list. (Well…most things, anyway. I’m human.)

This has been on my mind for most of the day today, probably because I had intake with my new therapist yesterday and was thinking about the wall between my thoughts and feelings. I depend so heavily on that wall to keep it together, and I’m a bit worried–or, okay, a lot worried–that once I start really delving into the trauma and trying to merge my thoughts and feelings that there will be this monumental change and I’ll basically fall apart. I can’t remember the last time I was able to feel an emotion on an actual deep, meaningful, emotional level for more than a flash before cognition takes over and the brain reasserts control over the “heart.”

I know that’s unrealistic and that no one can do a total 180 in terms of functioning, but the unknowns are scary. As horrible as it is to know certain emotional things but not be able to feel them…better the devil you know than the devil you don’t, right?

I haven’t had self-doubt like this in quite a while, but getting the thoughts down on this little blog has helped a bit. It’s funny how writing about your troubles takes away some of their power, isn’t it? I’m also going to hit the self-care pretty hard tonight because tomorrow I have a phone interview with another prospective internship site–yay! That search is pretty terrifying, but I have a good feeling about the last couple of sites I’ve contacted, so fingers crossed.

Until next time, readers, remember to take good care of yourselves. I will, too.

 

News Day Tuesday: Childhood Mental Illness

Good afternoon, readers! This week, I’m featuring an article from NPR related to the early detection of mental illness in children. Child psychologist Rahil Briggs states that half of all children show signs of mental illness before age 14.

On a personal note, I began experiencing symptoms of post-traumatic stress disorder around age seven or eight. My mother had gone to prison when I was six years old, and I went twice a month to visit her at the correctional facility that was several hours from my home. By this point, nightmares were a common occurrence–I’d had them regularly since age five–so my guardian and other relatives didn’t think much of it when the frequency increased slightly after these visits began. There was some talk of finding a therapist for me, but the idea was abandoned.

One of the earliest memories I have of PTSD-related symptoms was one night when I was attempting to play chess with my aunt in the basement of my grandmother’s home, where I lived for the majority of my childhood and adolescence. I began to feel odd, detached from my own body and my surroundings. I remember saying to my aunt, “Do you ever feel like you’re in a dream?” because that was the only way I could describe it at the time.

She had no idea what I was talking about and gave me a strange look, a reaction for which I can’t exactly blame her–if I weren’t “in the know” about the symptoms of PTSD, I would have found such a statement very strange.

As a child, I was generally calm and reserved, but I did occasionally “act out.” I would get panicky and anxious, a tiny ball of pent-up energy and what I can only describe as rage at nothing in particular. That energy had nowhere to go, so it was directed inward, causing lasting damage before finally exploding outward. I would storm around the house in a dark mood, only to erupt moments later in a fit of crying so intense I felt like I couldn’t breathe.

My family was helpless to help me because they didn’t understand–or perhaps didn’t want to accept–the reality of what was happening to me. Bipolar disorder, which has spread throughout the family tree like Spanish moss, was beginning to wreak havoc on my still-developing brain.

Childhood mental illness is a tricky subject. It’s hard to recognize, and it’s terrifying, both for the sufferer and the child’s loved ones. It can strike anyone at any time, regardless of socioeconomic class or education level or how strong the family’s ties are. Therefore, it’s especially important for parents to remember and impress upon their children that it is an illness like any other and is not a moral or character judgment. It is not evidence of parental failings or proof that the child has not been loved enough. It simply is, and the earlier it is detected, the earlier treatment and healing can begin.

Did you start showing signs of mental illness in childhood, readers? How did your family/caregivers react?

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