Not long ago I wrote a blog entitled “the only mental health diagnosis” identifying it as trauma-related, and hence PTSD. This remains my opinion of the plethora of diagnoses that are so popular these days. As I previously noted, people simply want to make sense of ails them, whether their feelings, their behavior, their thinking, or their relationships. In almost all cases the ailment is due to the traumata that they have had in their lives, particularly the emotions associated with the traumata. In this blog I want to suggest how a person can get over the causes of his or her PTSD, ideally without even labeling it as PTSD, much less anything else. We will briefly discuss the following:

• What is a trauma
• What is PTSD
• Finding the trauma
• Facing the trauma
• Feeling the trauma
• Finishing the trauma
• Forgetting about the trauma
• Forgiveness regarding the trauma

What is a “trauma”?

A trauma is any unsuspected event that has deleterious effects on the individual. This negative effects could be physical, emotional, cognitive, or relational. In other words traumata are not restricted to the physical assaults, like sexual assaults, that occur to people or the physical wounds that one acquires in the theater of war. The essence of a trauma is not the event or the damage done to the individual, but rather to unexpected nature. In other words, we are traumatized by something harmful to us in some way that we did not expect. The general categories of traumata include:

• Physical trauma includes sexual abuse, physical abuse, physical damage that occurs in the course of a day, or physical damage that occurs because of war
• Emotional trauma is perhaps the most significant part of traumata and it is the most subtle. In fact, the large majority of PTSD comes from emotional trauma such as:
  • Not being given the privilege of feeling sad or angry when traumatized. Many children are simply not given the opportunity to feel these emotions.
  • Being given too much privilege of feeling these things. Some kids are given too much freedom of expression, which has the effect of their failing to govern their emotional expressions in adult life
  • Having an overwhelming feeling of fear during a trauma. This can cause an overwhelming feeling of not being safe in the world
• Cognitive trauma is less frequent but occurs when an individual is not allowed to think, express these thoughts, and experiment with engaging the world with appropriate thought.
• Relational trauma is usually mixed with cognitive and emotional traumata. Its essence is in the failure of an individual to develop meaningful relationships with other people.
• Neglect trauma. More prevalent in undeveloped countries, this is the phenomenon of an individual, usually an infant, who is not given enough nurturance or comfort to allow the brain to develop. Romanian orphanages are full of such children due to the former regime’s demand that Romanians have more children.

You can see that all of these traumata fall in the realm of the unexpected. I do not expect an adult to assault me, neglect me, or fail to allow me to think or feel.

What happens with one is traumatized and suffers PTSD? I encourage you to examine the many resources available, like Van der Kolk’s The Body Keeps the Score and the many articles that fall under treatment of PTSD, like EMDR. Very simply put, when traumatized, the brain has a reaction that ideally allows the mind to make sense of what has happened. I could be traumatized by seeing a child drown but not suffer PTSD if I am allowed to feel through, think through, and perhaps act through this situation. Again, very simply put, there is a brain function that occurs with any trauma, which is first emotional, secondly, cognitive, and thirdly behaviors. Of these three operations the usual cause for PTSD is the failure to feel the emotion associated with the trauma. Thus, most PTSD is the brain’s having failed to find, face, feel, and finish the emotions associated with the trauma, and then go further to forgetting and forgiving as deemed necessary.

Finding the trauma in PTSD

This can be an easy task or a difficult one because the trauma could be forgotten or repressed in memory or for some other reason, like having suffered something that seemed right at the time and necessary. Some people artificially “forgive” a parent for abuse or neglect because they love their parents and understand that their parents were not able to avoid physical abuse or neglect given their parents’ own personal history or other circumstances. A woman whom I see in marital therapy was raised in an environment where she was not allowed to have any expression of sadness or anger in addition to her mother being delusional. There are other more complicated cases when a parent is physically or mentally unable to properly care for a child. In wartime soldiers often think something like, “this is necessary to do, and there is not time or place for feeling sad, angry, or afraid because I need to the job at hand.” Circumstances like this impairs the individual from feeling, thinking and doing something in the face of the trauma. In almost all such cases the child does the right thing to keep feelings, thoughts, and behavior to a minimum to avoid being more seriously damaged. I just met with a young woman who knew that her mother was inclined to rage and abuse, so she wisely kept her feelings and thoughts to herself and “managed the situation quite well,” as she said. This wisely keeping thoughts, feelings, and behavior to oneself is the cause of almost all PTSD.

Find the trauma or trauma in one’s life can be taxing. First, you don’t want to do it. Naturally, you don’t want to dredge up “dirty laundry” and “focus on what was wrong,” admirable behavior but also emotionally costly and ultimately costly. A man a recently saw for a neuropsychological evaluation said such things about his childhood, which was evidence of his good character development, but also evidence of why he suffered from Chronic Fatigue Syndrome, which is well established as caused by PTSD. So, finding the trauma can be traumatic in itself as you try to see where you were first traumatized. Furthermore, if you suffer PTSD, you have had one or more experiences of being re-traumatized over your lifetime. This means that you had the original trauma, say being left alone for an extended period of time, but you have been “left alone” for necessary reasons many times in your life since then, and perhaps many of these felt traumatic. Read Van der Kolk’s book on how the brain gets re-traumatized.

Finding the trauma or traumata can be challenging. First, of course, you don’t want to do it because it will bring up painful memories. Secondly, you can’t do this alone. You need a competent therapist to assist you in the process. Let’s go on to the process

Facing the trauma

Facing the trauma takes a bit of time. This could be seconds or days but not months or years. Facing something that you have perhaps lived with for years is a challenge because it has become part of you operating fabric while not really a part of the fabric of your soul. Facing the trauma is naming it for what it was: traumatic. You might be able to label it more specifically as abuse, neglect, or indulgence but that may not actually be necessary. Yes, indulgence can be traumatic because you weren’t given the opportunity to see limits of life and feel sad by not having what you want. It is enough that you find the origin of your PTSD the best that you can. In fact, you may not be able to find time, place, or person involved in the original trauma, but you can find how you felt.

When you face the trauma, you will face the three things that we have discussed: feeling, thoughts, and action. In other words, you will see how you felt emotionally, what you thought cognitively, and what you did as a result of being traumatized. You need to recognize all three of these elements of trauma in order to resolve the trauma because you ultimately need to feel through the trauma, think through the trauma, and possibly take some action in your current life. You may, for instance, fallen into a dangerous relationship with someone that you need to end because the individual re-traumatizes you; you may be in a job that is not good for you because it re-traumatizes you; or you may need to move out of you home state or back to your home state. In all of these actions, you thinking must be clear, not affected by emotion. But to be able to make a good rational decision as to what to do, you have to do the hardest part: feeling the emotion that is always associated with traumas.

Feeling the trauma and finishing it

This is the hard part, but the essential. It is hard to find the trauma and face the trauma but it is truly challenging to feel the trauma. What it mean to “feel the trauma”? It means to feel what you were unable to feel when you were originally traumatized. Furthermore the feelings, primarily the emotions, that trouble you in your current life were the feelings that you had when you were traumatized. The emotions were three, and possibly all four of the basic four emotions that we have as human beings: sorrow, anger, fear, and joy. The most lasting emotion that you have is fear, which then migrates into some form of anxiety. The frequent emotion that occurs with PTSD people is anger, often taken out on other people and oneself. The most important emotion you felt was sadness. Generally, you retain the fear most of all, the anger, secondly, the sadness thirdly. You might even have some residual joy in the experience odd at that might sound. Sexual abuse victims sometimes have to admit to themselves that they had some sexual pleasure when being violated, and army veterans have to admit to having some pleasure in killing people. More often, however, the predominant emotion is fear, which constitutes the bulk of the phenomenon of PTSD: people retain the fear associated with having been helpless in the traumatic situation. Feeling this fear is the hardest part because your brain most certainly does not want you to feel fear of any kind and will work against you feeling this emotion. If you feel fear and stay with it, you will then gravitate to the next stage of emotion, which is the heart of trauma resolution: feeling sad.

If you face the trauma, you will face the fact that you lost something that you loved. Most importantly, you will see that you lost a piece of yourself. You will see that your basic self was assaulted in some way and as a result you no longer felt entirely human. As a result of trauma, many people developed “dissociation,” which means a kind of separating their thoughts and feelings from reality, something that they learned to do when they were in the traumatic situation. Feeling the emotions associated with a trauma is difficult because you probably dissociated in some way at the time of the trauma in order to get through it. Indeed, you did “get through it” but at the cost of your having to repress the feelings of fear, anger, and sadness. Repression of these emotions is the heart of PTSD in your current life but you brain “helped” you get through the trauma by doing that very thing. Naturally, you don’t want to feel these emotions now, and your brain will try to keep you away from them, but the task is to feel all of them in order to be restored to your true self. Facing the anger you felt (but couldn’t express) is the easiest part, even though it is difficult, and fear is much harder to feel, but the most important thing you have to face is the sadness associated with the loss you suffered. If you lost a leg in war but weren’t allowed to feel sad, you need to feel sad now in order to resolve the trauma. If you lost a sense of self, or perhaps self-respect, when you were sexually, physically, or emotionally traumatized, you need to feel the sadness of having lost a part of yourself.

Fear is the most basic emotion we have and it keeps us alive. Sadness is the most important emotion we have and it allows us to love, lose, cope with loss, and love again. You want to love again, but you will be able to do this only when you no longer hide the sadness you have from the original trauma. You can feel sadness and it will end but you most certainly don’t want to feel this sadness. No one does. You need a good therapist to help you through this grieving process. Perhaps you lost an arm, your voice, or something physical like your favorite toy, but the most serious loss you have suffered in the loss of self. Grieve the loss of self and you will find self. You will be free to love again, lose again, and love again all over again. You have finished your grief. When you have finished grieving, you can think clearly and then take action. It is not enough to just feel sad. You need to see how what you might need to do in your current life that takes courageous action based on wise thinking. You can think wisely and act courageously when you are not burdened by old hurts. You’re almost done. You need to forget and maybe to forgive.

Forgetting the trauma and forgiving

I have to be careful in discussing the forgetting process of trauma resolution because it is not a failing to remember the event or events that were traumatic in your life. Rather, it is no longer focusing on them, no longer being dominated by the unfinished business of grief associated with old traumas. People who have “finished” the feelings associated with sexual trauma, for instance, remember the time, place, and person during the trauma but they are not fixated on this event. It is history but it is not current events. What they have done is to have faced the fact of the trauma and faced the feelings associated with the trauma. Now, they don’t have to look back at this horrible time in their lives with fear, anger, or sadness. It is history. When a war veteran can speak of having killed some 13-year old boy who was shooting at him in Afghanistan, and then allow himself to feel the fear, anger, and sadness related to this event, he will not forget the boy nor having killed this boy but he will be free of the emotions associated with this tragic event so he can go on with his current life unburdened by old emotions that belong in the past, not in the present.  He might even go further: he might need to forgive….

But what is he forgiving. He is forgiving the boy for shooting at him, the Taliban who recruited this boy to shoot him, and American President who started the war in Afghanistan, and the captain who ordered him to kill this boy (or be killed by him). He might even need to forgive himself, although forgiving oneself is a bit more complicated and not a part of this discussion.

Find, face, feel, finish, forget and forgive. That is the resolution of traumata and resolving the PTSD that often results from it. Find a good therapist who can help you do these things.