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The Many Faces of PTSD

Holy Macro! Books

Brenda

Her Story

She came into the Victim Assistance office early one morning with a four year old in tow. She had gotten the older child to school and somehow found her way to us. When she and the child came into my office, and we shut the door, she started sobbing uncontrollably.

She was a battered and abused wife, and she looked the part. Her thin face was without color, her blondish hair without style, her clothes without form. The child looked terrified. He buried his head in his mother's lap and cried along. I felt like crying, too.

Her fear was for the boys, especially the one in fourth grade whom her husband had recently started to abuse. She could take it; she even thought she herself deserved it. After all, he did everything. The translation of "everything" turned out to be that he provided all the money. She couldn't even get the house straightened up or get a good meal on the table.

I was as new to the business of being a therapist as she was to the business of being a client. We muddled along together as her story told itself. She was not a woman you could warm up to. She was devoid of the social niceties: no manners, no appreciation, no interest in anyone other than herself and her children. In fact, she felt to me like a bottomless pit. What could ever be enough to fill this woman's heart and give her some hope?

Within six weeks I thought we were doing extraordinarily well. She was out of the house and living in a battered women's shelter. She had gotten a haircut, some clothes that fit, and she reported that her school -aged child was happy at the shelter. The four year old looked like he had gained some weight. He had some color in his cheeks as well as a little bag of toys he carried with him now. Brenda was enrolled in a program to retrain housewives. When she finished that program, they would help her find an apartment and a job. Legal aid would enable her to sever her abusive relationship and hopefully get some child support.

Clearly her self-esteem was that of a battered person under the control of an abuser. She had no car of her own, no independence, no family in the area, and no money she could access. Her husband, a long-distance truck driver, would take her to the grocery store so he could oversee her purchases. When he left on a trip, he'd leave behind the car with an empty gas tank and a twenty for her week's spending. That, though, was preferable to the irritable iron fist he wielded when he was home. He'd recently beaten the ten year old with his shoe because the boy had given him a disrespectful look. Then he took the four year old out for ice cream.

Brenda had a lot of bruises and breaks, too. She made up stories about the causes of her injuries, as well as the reasons for the older boy's broken arm. She knew the ER doctors didn't believe her, but they let her tell her tales. Her last ER visit was for a dislocated shoulder and a broken nose. Quite a fall.

She knew she needed to leave him. She even wanted to leave. She absolutely astonished me when she actually did. We had worked together to find the resources, but only she could take the action. She was terrified, but she did it. I'm sure my explanation of how Children's Services Board (CSB) would have to be involved if either boy was harmed again helped her find the strength. She didn't want to be home with her husband when CSB came knocking on the door. That would have been hard on everyone's bones.

For ten weeks, she never missed a therapy appointment. Then she disappeared. I was scared for her. She finally checked in a couple weeks later to tell me that she had called her husband so he could talk to the boys. She thought it was "only fair." So her husband came and got her and the boys and apologized, and now they were all back home together and everything was wonderful. This part of the cycle, I was to learn later, is called "the honeymoon phase."

Her Signs

Domestic violence can be one of the ways that PTSD presents itself. Typically, the abuser will be a man who has been the victim of childhood abuse, and the abused will be a woman who has been the victim of childhood abuse. These childhood traumas may have been sexual, physical, emotional, and/or psychological and may have been abusive or neglectful.

We are not talking about discipline. We are talking about abuse. When children are disciplined, they know what they did. The discipline may be extraordinarily harsh, but the children seem to understand. "I ... (did thus or so) and the old man beat me with a board. I couldn't sit for days." This is discipline. Harsh discipline, but still discipline. This story is frequently told with a laugh. Abuse, on the other hand, comes out of left field. The abusive story usually begins with the action of the abuser: "He slammed me up against the wall because I didn't give him a morning hug!" This story is told with disbelief and disdain. Discipline is frequently tied to something a child did do. Abuse is frequently tied to something a child didn't do.

The domestic violence abuser will usually, but not always, be a man. The abused will usually be a woman. Men tend to act out, and women tend to internalize. Please understand that these are generalizations and stereotypes. (All we need to do is look at same sex relationships to see the exceptions.) However, generalizations and stereotypes don't make themselves up. They evolve from repeated examples.

So, Brenda, a victim of domestic violence, was most likely a victim of childhood sexual abuse who married another victim of childhood abuse, and he took the role of the perpetrator and she took the role of the victim. Logically, you can't have a perpetrator without a victim or a victim without a perpetrator.

And then there is the third role: that of the witness. Sometimes the witnesses are innocent, as in the case of Brenda's children. Sometimes the witnesses are complicit, as in the case of an adult family member. More likely than not, this family member/witness is the wife of the perpetrator or the mother of the perpetrator. Imagine the mother of the perpetrator, the perpetrator being perhaps the older brother, being also the mother of the victim, who, let's say, was the younger daughter. This is a scenario which is not infrequent. An all-too -common reaction for a complicit wife, mother, sibling, etc., is silence. And innocence. And lack of knowledge. This is actually understandable because some things are too horrible to know or accept. But it is intolerable and immoral. We cannot not know what we know, no matter how much we want to.

All of this said, we must then conclude that in the cases of PTSD rooted in childhood abuse and neglect, we are dealing with a cycle. This cycle is often intergenerational and inordinately difficult to break. I have said to a number of courageous souls over the years, "Congratulations! You have done what no one in your family had the strength or insight to do before. You have broken the cycle!"

(You can read about the cycle of abuse by simply looking up that term.)

The previous five paragraphs were a necessary introduction--the Cliff Notes on how systems or families pass on dysfunction and how PTSD is an all too frequent result. Now, on to Brenda's signs.

Brenda came loaded with indicators of PTSD. Most telling was the symptom I have come to believe is the cornerstone of PTSD: shooting oneself in the foot. Many survivors seem absolutely unable to tolerate prosperity. When things start going well and the stars start aligning for good fortune or serenity, victims often have a great idea. For Brenda the great idea was to be "fair" to her abuser and give him a chance to talk to the kids.

I often think if victims were wrestling a snake and had the snake immobilized, they'd start feeling badly that the poor snake hadn't had a chance to bite or strangle. Their hands would loosen out of pity and a sense of how it has always been - - how we gravitate toward the familiar - - and the rattler would bite and the python would strangle.

Snakes, whether reptilian or human, are notoriously lacking in the fairness gene.

Now, why victims of abuse react this way is understandable. When you have been bitten or strangled all your life, all you know is being bitten or strangled. Whatever we have predominately experienced in life becomes our normal, our reality. If we have been fed three healthy meals a day every day of our lives, then when we are left to our own devices, we will eat three healthy meals every day. If our clothes have been laundered and our living room floor vacuumed, we'll just naturally wear clean clothes and walk on clean floors. It's what we know.

If, on the other hand, we have been told we are stupid or ugly or incompetent or needy or crazy, we will act like we are all those things and attract people who will treat us as we believe ourselves to be. The abuser repeats the abuse message until, at some point, the message is internalized and the abused person becomes his or her own abuser.

The message resides inside us.

So, Brenda found herself, put herself, and accepted herself in a one-down, "this is as good as it gets" position. She married what she had grown up with--control and abuse.

When she worked to get herself out of the control/abuse cycle, she couldn't tolerate the dissonance, in other words, the difference between what she was accustomed to and the "new" normal, and so in her low self-esteem and passivity, she slid right back into victimhood.

Again, the reason is understandable. (At least to me, after twenty-two years of sleepless nights trying to figure it out.) Anxiety. We are going to talk more about anxiety in book two of this series, The Many Faces of Anxiety, but for now, we need to understand the following about anxiety. When things aren't normal, we get anxious. What was normal for Brenda was to be controlled and abused. When she wasn't in that familiar state, she kept waiting and wondering when it was going to come. In Al-Anon, they call this 'waiting for the other shoe to drop.' When will the alcoholic start drinking again? When will the abuser start abusing again? The only way to escape and reduce and diminish or extinguish the anxiety is to get back to normal.

Does this mean Brenda liked being controlled and abused? Hell, no. Of course not. Absolutely NOT. However, BEING abused and controlled saved her from ANTICIPATING being abused and controlled and the resultant anxiety. Will it be when he walks in the door? Before supper, when he realizes their younger son is throwing up? During supper when she has burned the rolls? After supper when there is no dessert? While watching television, when the teenager interrupts them to ask about a homework assignment? Before bed when she doesn't respond quickly enough to his sexual needs. During the night ...

When we are waiting for something we dread to happen, the waiting, the anxiety, keeps us in a state of hyper-vigilance and hyper-arousal. We have to constantly scan our environment to see where the abuse will come from. Our radar can never be turned off.

We must remain in a state of adrenalin-pulsing readiness so we can withstand the onslaught. In other words, chemically, physically, emotionally, behaviorally, intellectually, we can never relax. Until the abuse comes.

This is a gross example, but one with which almost everyone can identify. You know how good you feel right after you throw up? And then slowly the nausea and the wooziness and the aching start again and you rush back to the bathroom and sit over the toilet just waiting and watching, all tense. Your head gets hot, your cheeks flush, your back and shoulders knot, your stomach rolls, your mouth fills with saliva, your legs ache, and your heart races. You are prepared for the next onslaught of vomit. And then it comes, and mercifully you get to relax for a little bit. Your body uncoils and you break out in a cleansing sweat and you lean back feeling like a victor. You have withstood another round in the ring with Mohammed Ali.

Throwing up is in this minor way like getting abused. You can only relax when it's over. That's when you get a break. That's when you can breathe a full breath. After it's been over for a while--and how long the while is will be different for each victim--the tension starts building and you find yourself in an increasing state of readiness. The light slowly filters from green to yellow to orange to ... Red. It's almost a relief when the abuse comes, because like the vomit, it allows you some peace. Until the next time.

And so, Brenda shot herself in the foot, hid in her passivity and returned to her normal, familiar state of being abused. The continual, building, unrelenting state of anxiety was too much to bear.

Her Steps

Brenda was very, very brave. She defied all the rules of control and abuse and she told. Rule #1 of being a good victim is to never, ever tell. Not anyone. Kids learn this rule really quickly when the first person they tell--often that silent, complicit conspirator--shuts them down with some version of "You're lying!" or "How can you say that about Uncle Mike?" or "What did you do to deserve that?" or "You are such a bad girl!"

Kids are also pulled into the conspiracy of silence by messages from the perpetrator: "This is our secret" or "Only grandpa is allowed to love you this way" or "You know daddy won't be able to live here anymore if anyone finds out you and I do this" or "Your mommy would never forgive you if she found out what kind of girl you are."

Brenda had held her secrets for years. It was when her fear for her children became stronger than her fear for herself that she told. And so she found a safe place: Victim's Assistance. This is one of a growing number of safe places along with emergency rooms, churches, synagogues, and, I would hope, every school in the nation, not to mention every police station, fire station and court house. "Please, help me. I'm a victim of ..." should be all it takes.

But Brenda couldn't tell the ER docs until that one day. From there, she took, after telling, what for her was step #2: she engaged in therapy. She and I talked about what constituted abuse. Often we need someone to validate and name what it is we are enduring. "If you can name it, you can tame it," my mentor Phil used to say.

We talked about Brenda's feelings, her fears, her weaknesses, her strengths, her options. At first she seemed to simply find acceptance in therapy. Slowly she started to find some of her own inner strength. Then she seemed able to take some action to help herself and her children.

Step #3 for Brenda was to remove herself from the abusive situation. She went to the Battered Women's Shelter and began reconstructing her life. The social workers and therapists and chaplains and volunteers at such shelters have helped countless women to do this. They know what the steps are. They have group activities and group therapy sessions, both formal and informal, and many resources for support and sustenance.

Brenda was able to tolerate this for a number of weeks. And then her anxiety and her old ways of being and thinking overrode the fear for her children and the new options she had worked so hard to find.

I certainly could never blame her. I understand. Who we have been, and who we have come to believe we are, is a strong, cemented legacy. Good, bad, indifferent, it is almost impossible for us to rewrite our life script. If we do succeed in a rewrite, it is unlikely to happen in twelve weeks, perhaps not even in twelve years.

Also, it is possible that by Brenda's very act of telling, her husband will have found it wise to tone down his behavior. She broke the silence and showed him that there were things she feared more than him. It is also possible that if the abuse continued unabated, Brenda got out again--and perhaps stayed out. She showed him a thing or two and she showed herself a thing or two as well.

My Story

The lessons here, for a budding therapist, were many. Number one is a lesson on which I have based my practice ever since: "No credit. No blame." You make changes in your life, good for you. I'm happy to walk the path with you, but I didn't accomplish the victory, nor am I responsible for the defeat. (It's great to learn humility early on in any profession!) The cycle of abuse, and, as we'll see throughout this book, the pull of addictions and the disabilities of unformed and compromised egos are greater than the skill or love of any therapist. Only a therapist, plus an open-minded, determined, courageous client, plus that magic third component (call it God, faith, hope, mercy, luck, karma, whatever ...) can withstand and overcome the quicksand of our early imprints.

A second valuable lesson Brenda taught me is to expect and predict regression.

Who among us ever learns the whole lesson in the introduction? Getting good at anything takes practice. The lessons we are trying to learn here are about appropriate assertiveness, ego strength, boundaries, the balance between self and other, trust, living in the present, and, one of the most challenging, forgiveness. Forgiveness of others, to be sure, but also, and sometimes more importantly, forgiveness of self..

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Excerpted from The Many Faces of PTSD by Susan Rau Stocker, Alice J. MacDonald, Malvina T. Rau. Copyright © 2010 Susan Stocker. Excerpted by permission of Holy Macro! Books.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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