Trauma Training Tip
Metal “type” trauma survivors are often overcome by grief. They may experience a very primal sense of shut down. It is hard to inhale – to receive life – and any of the gifts that are here for them now – or exhale and let go of their past. The question, “How can a loving God allow bad things happen to good people” is tormenting for them. Their breath may be shallow and they may have deeply soulful survival guilt.
Patients with survival guilt may feel grief or shame for surviving when someone else didn’t; for not doing something that they imagine they could have done to save someone; or for the actions they took to survive – such as climbing over others to escape a sinking ship or burning building. These feelings can consume them.
Who survives and who dies and why is a question that has no answer. We can’t begin to understand why someone’s destiny is to survive and someone else’s is to die an untimely death. We all will die, the when and the why is beyond our comprehension.
It is important to affirm the concept of destiny and our powerlessness over it for someone with survivor’s guilt. It is alsoimportant to explain that the will to survive is embedded in our physiology. We don’t get to over-ride and make a different choice with our mind. Primitive and primal instincts rule our actions, not cognitive choices. We could not have made the choice to die instead. We all want to live.
Helping these patients discover that they have more emotions than their consuming guilt and grief can be very helpful. We are complex creatures, even when grief feels overwhelming, other emotions are also alive inside us at the same time. Can they discover another feeling or experience of their life? Can you help them acknowledge their unique contribution to life? Can you help them find and allow their joy in being alive? “Are you glad you are alive?” is a poignant question that may allow an experiences of pleasure to begin to emerge along-side their grief.
Alaine’s Two Cents
The roots of the dysregulation adult survivors experience is often found in childhood, developmental trauma. I highly recommend Nurturing Resilience: Helping Clients Move Forward from Developmental Trauma–An Integrative Somatic Approach for understanding your clients, and perhaps yourself!
Written by my co-author, Kathy L. Kain and my colleague Steve Terrell, it offers an introduction and practical, integrated approach for therapists working with people (both adults and children) who have been impacted by developmental trauma and attachment difficulties.
“Kathy and Steve draw on fifty years of their combined clinical and teaching experience to provide this clear road map for understanding the complexities of early trauma and its related symptoms. Experts in the physiology of trauma, the authors present an introduction to their innovative somatic approach that has evolved to help thousands improve their lives. Synthesizing across disciplines–Attachment, Polyvagal, Neuroscience, Child Development Theory, Trauma, and Somatics–this book provides a new lens through which to understand safety and regulation. It includes the survey used in the groundbreaking ACE Study, which discovered a clear connection between early childhood trauma and chronic health problems. For therapists working with both adults and children and anyone dealing with symptoms that typically arise from early childhood trauma–anxiety, behavioral issues, depression, metabolic disorders, migraine, sleep problems, and more–this book offers fresh hope“
Check This Out
Much of the development of understanding of survival guilt and moral injury has come from mental health providers and ethicists working with Veterans of the current conflicts.
Frank Ochberg, psychiatrist and pioneer in modern psychotraumatology makes a clear distinction between the features of what is commonly known as PTSD, with its roots in terror for one’s own survival, and moral injury, with its roots in a violation of our inner sense of integrity and honor.
Where is your clinical curiosity carrying you?
Send me a question or two and I will explore them with readers in this corner next month.
Q. I have a patient whose teen-age son died in a tragic car accident. He is consumed by guilt for giving him the keys to the car that night, not teaching him defensive driving, for being unable to protect his son. He is literally consumed by grief, and it is 15 years later.
A. So glad he has you. His grief is consuming his mind and heart — but it is in his tissues as well. It is likely complicated by dozens of other experiences of grief, guilt, shame or loss that stick together like velcro inside his body/mind.
Helping him to be curious about the physiological sensations that come with his grief is the first step. Guide him in noticing the felt sense of his grief. Does his breath become shallow? What helps his diaphragm to let go? When the tears complete, how does the table feel? You will be supporting his Po/Animal Soul to come to peace with the unknowable, “Why do bad things happen to good people?” Being curious about his felt sense or what is often called his interoception by somatic psychotherapists, will help him tease apart the many features of his loss, let go of one aspect at a time, and lighten the sense of overwhelm about its enormity.
I hope he is also working with a good grief counselor who can help him explore the many layers of meaning such an experience has. Their work will support your exploration of how his tissues are storing his experience.