G avin is a good looking man in his thirties and he walked confidently into the consulting room. It was hard to guess that his self-assured manner was masking a lot of psychological difficulties.
It became clear that he was suffering from a profound sense of disconnection at multiple levels following a traumatic event, as the incongruity between his persona and his subjective sense of self was slowly revealed. Post-traumatic stress disorder has a sense of disconnection.
The parts of the brain responsible for our survival responses are activated quickly in response to trauma. Our cognitive processing systems are disconnected from our instinctive feeling states.
A sense of disconnection that runs deeper than this blunt survival response is what trauma elicits. The effects of a traumatic event can be felt inside.
The disjunct between his sense of self before and after the traumatic event was the most striking of the different levels of disconnection. He came to therapy because he didn't know who he was anymore. I used to know, but now I don't.
The essence of trauma is disconnection from ourselves, and this certainly appeared to describe the experience ofGavin.
On the day that a man was murdered in front of him and his girlfriend in a local park, his life had been completely altered. He found out that the attack was part of a gang feud.
Since this incident, he had been experiencing a constant sense of paranoia. In the past he thought of himself as balanced and even-tempered, but now he feels jumpy and over-stimulated and has a short fuse. The times alternated with periods of feeling numb and out of it. I either feel too much or too little according toGavin. Who is I? The person who feels too much or the person who feels too little?
He believed that he had been cowardice in not trying to intervene in the attack. He said that the image he had of himself before that day was poles apart.
He couldn't believe that his girlfriend wasn't judging him because he had been told there was nothing he could have done differently. He ended the relationship because of it. He was reminded of what had happened when he was with her. He had been avoiding his male friends out of a sense of shame and he felt distanced from his family. He believed that it was better to be alone when he felt so angry.
As we began to unpack his story, it became clear that he was suffering from the classic symptoms of post-traumatic stress disorder. He found the sense of disconnection distressing, even though the flashbacks and anxiety were troubling for him. He felt disconnected from his body, he felt lost from a sense of continuity, and he was isolated from his friends and family.
He felt disconnected at a spiritual level as life no longer had any meaning or purpose. He was preoccupied with mortality at the same time.
It was clear that a multi-pronged approach to treatment would be necessary as the difficulties thatGavin was experiencing in the wake of his exposure to an acute trauma were multi-tiered and complex.
An important priority was to change the rapidity with which his brain was pushing him towards automatic fight, flight and freeze responses. Eye movement desensitisation and reprogrammment (EMDR) was found to be helpful in this regard. The second priority was to get him to get back into the gym and exercise that he had been doing before the incident.
The third priority was to deal with all the psychological andInterpersonal disconnections that had flowed from the event. He was recommended to engage in therapy so that his reactions to the event could be normalised and his internal conflicts and guilt addressed.
He made good progress in therapy and was able to connect with both himself and the world. To help him to come to a deeper acceptance of the unpredictability of life, part of the work was to restore him to a sense of invincibility.
We draw over these veils in order to protect ourselves, but in some ways, post-traumatic stress disorder puts us in touch with life's realities. If the realities of trauma can be accepted and integrated, we can be more connected to life than we were before.
The philosopher said that a person can be measured by how much truth they can give. To accept the truth of our own vulnerability and the unpredictability of the world is a task and the working through of trauma provides us with this opportunity.
The Talking Cure was co-authored by Gill and Dr. Winship. Gill is on the show Three Associating, in which therapists explore their blind spots.
There are many similar cases. Both authors wrote about the therapist.
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