7 Days

Last Friday: Served as translator (English/Spanish) for patient complaint to administration meeting.  The person I was translating for spoke 2 sentences total…at the end of a 2 hour meeting.

Next, I went down to emergency department to speak to a pregnant woman who may be referred to our Maternal Addiction Treatment (MAT) Program. Me (at the bedside): “Hi, I know you’ve had a rough last few hours…I’m here to talk to you about treatment and a way to recovery.”  Patient: “Can you come back? I feel like shit and I have to go to the bathroom.”  I still did my behind the scenes thing….coordinating with the psychparmacologist, the other half of the MAT dyad to review the case, get the labs and meds she needs ordered, arranging for an inpatient bed, informing ER doc & psychiatrist of status, getting OB online.  If it wasn’t for my MAT partner who kept checking her chart and coordinating care with MD and nursing staff, I wouldn’t think of her again until Tuesday.  Once she got admitted to the unit, reports say she was irritable, uncooperative and refused OB monitoring.

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Notes from the Field: Non-Judgementally 

3 new members started in our Thursday DBT Skills group today. For mindfulness practice I played a song, “On my Way” by Valerie June. A cute blues tune.  I chose it for no other reason than it was jaunty and short. I also happen to really like Valerie June’s entire album. 

The women hated it. HATED THE SONG. And were very vocal about it. 

One spent the time picking out everything that was wrong with it. The other trying to analyze WHY I would play that song for mindfulness practice. Another heard only the word “June.” Another looked past her judgements and found something interesting in the instrumentation. 

I could not have picked a better song to underscore the “How” skill of non-judgementally. We were able to observe all the judgements that arose, illicited by a simple 3-minute blues song. The difference between observing the present moment with a “beginner’s mind” versus avoiding, categorizing or suppressing reality was an experiential discussion. All thanks to a little blues song. 

So often we take for granted that each moment is new, that each thought and sensation is fleeting. And by holding on to judgement, we block the wonderous  experience of reality as it is. We chose instead to be confined by our anxiety, preconceptions and biases. 

Today in group, for 3:29 minutes while listening to Valerie June, I was awake. 

Putting Freud in His Place 

“THE STUDY OF PSYCHOLOGICAL TRAUMA has a curious history— one of episodic amnesia.”

Judith Herman (1992) makes this claim, noting the study of trauma is fostered by a supporting political movement. To study trauma is to take sides between the victim and the perpetrator, and ” The victim demands action, engagement, and remembering.”

Since the moment I read Freud’s psychosexual theory I thought he was a huge phony. But it wasn’t until I read Judith Herman’s “Trauma & Recovery: The aftermath of violence-from domestic abuse to political terror” that I became aware of why I hated Freud and his Oedipus Complex. Freud, following the work of Charcot in 1885, studied hysteria. By 1896 Freud published a seminal work linking hysteria to sexual trauma in childhood. A year later, however, Freud repudiated this link, developing instead an intricate theory attributing hysteria and other psychological problems to a child’s libidinous urges toward the parent of the opposite sex. 

To acknowledge sexual trauma as the cause of hysteria would be to acknowledge that sexual abuse of women and children was rampant. Freud decided to maintain the patriarchal status quo and develop instead a theory that promoted the continued subjugation of women and ignored the damaging effects of trauma on the psyche. The depths of the lies housed in Freud’s theories are so aligned with society’s need to keep silent about trauma that his theories are still discussed today. Today, however, I am conscious of the deceit and can create a new space for truth for me and my clients. 

The truth is that I too have participated in the crimes of omission. Regarding trauma, I have taken the side of the perpetrator in my clinical practice. I have perpetuated silence and forgetting instead of acting on behalf of my clients and engaging with them unearthing their trauma. My motives then were to protect the client from my own ineptitude. I did not know how to work with trauma. I also had not studied how to treat it. 

My clients may have suffered in my hands because of my lack of awareness. One of my clients suffered a horrible trauma at the age of 10. What happened to her at the hands of a neighbor was compounded by the invalidation and emotional abuse perpetrated by her parents. I asked her about trauma on her first day of therapy. Because I did not feel prepared to help her (I had to study more, learn more), we did not address the trauma directly until a year into her treatment. By then, I’d become a dialectical behavior therapy (DBT) clinician and I’d begun reading Bessel van der Kolk’s “The Body Keeps the Score.”

I worry now that I did her a disservice. That waiting as long as I did may have capitulated the invalidation she got from her parents. I know that by the time we were both ready to address the trauma head on, she was courageous and fierce. I’d like to think that I was also. She was fearless in writing the story of her trauma on a piece of paper we burned. Standing outside my facility with a borrowed lighter we burned the paper after she read each horrible word out loud. She credits that moment to her liberation. Her life still had the same ups and downs but after that day she felt she had crossed the abyss from victim to survivor. 

She has taught me, more than any book, that I can help my clients and now I am no longer silent. I speak to trauma, I say the words out loud. And hopefully, I help clear a space where others can speak and remember out loud.