CUMULATIVE TRAUMA – With Love from Dr. G
Cumulative means accumulated. It’s a word used to refer to the addition of some sort of element on top of another, little by little, again and again. Cumulative trauma is a term used to describe a disorder in medicine in which micro-injuries can occur from repetitive stress on joints, tendons, muscles, and nerve tissues. It results from the wear and tear over time on specific parts of the body. But cumulative trauma can also be used to describe the insidious accumulation of severe stress or traumatic experiences over time. It may be helpful to explore the mechanism by which trauma after trauma after trauma can lead to the deterioration of a person’s mental state and health (both psychological and physical). Please refer to previous articles for further understanding of some of the concepts discussed below (see route91therapy.com). Important NOTE: In the world of treatment, all traumas regardless of nature (e.g., combat, rape, child molestation, life-threatening events, domestic violence), are equivalent in the sense of how they impact us. Very interestingly, despite vast differences in the details of these traumas, people typically end up experiencing similar issues in the areas of safety (physical), trust (physical, emotional, etc.), power and control, esteem (how we feel about ourselves and other people), and intimacy (closeness and attachment to others).
Let’s start at the beginning. When we are born, we have a clean slate, with no beliefs about the world, ourselves, or other people. As we grow, we absorb a ton of information from our environment. Ideally, we are taught appropriate behavior in social situations, healthy boundaries, and a positive sense of self. In some cases, however, our boundaries are breached repeatedly (e.g., childhood abuse/neglect), which teaches us our self-worth (or lack thereof). In both cases, whether from a happy or unhappy childhood, we form a set of core beliefs that inform subsequent life experiences. Then as time goes on, we learn new life lessons and we integrate them into our understanding of the world and our place in it. In the ideal situation in which you grew up in a loving home with supportive parents and did not suffer childhood trauma of any kind, you start out with a relatively positive set of core beliefs, but hopefully you also learned to balance your understanding of life over time (a healthy process called accommodation). Sometimes, even in the case of a happy childhood, you may have been taught some beliefs that cause problems for you down the line because they are too positive or too rigid. Similarly, if you grew up with lots of trauma, then you likely had a highly unbalanced and negative worldview that also may be too rigid.
The “Just World Belief” is the belief that the world is just and fair. Thus, good things happen (or should happen) to good people, and bad things happen (or should happen) to bad people. So you may believe that if you work hard, then you’ll be rewarded and your life will go well. But if you do something wrong, then you’ll be punished (or the common presentation of this belief – if someone else does something wrong, then they
should be punished). Typically we learn this as children and there is a developmental phase in which we like rigid rules to follow (for example, think about your own children and the phases they went through in which they were focused on things being fair). But generally we grow out of this belief system and we come to understand that good and bad things happen to good and bad people. This means you may as well throw out the words “good” and “bad,” because they lose their meaning. The real story? Shit happens. We learn that life is not always fair. We learn that even when we do everything “right,” things may go “wrong.” The problem is that following trauma, people often revert back to a line of thinking in which they blame themselves for what has gone wrong. After all, something bad happened, so they must have had a part in it. And back to the childhood and very rigid Just World Belief. We can get really stuck in life when we think in this way.
EXERCISE: Think about each of your life traumas, or at least the Las Vegas massacre at Route 91. Do you carry guilt, shame, or blame yourself in some way? If you do, and for some reason you have had difficulty challenging these irrational and unreasonable beliefs, then perhaps you are reverting (assuming you don’t typically still believe the Just World Belief) back to your child brain. Now think about the consequence. Are you punishing yourself because you were “bad” and should have done more? Time to work on compassion (again, please refer to route91therapy.com to read WHY COMPASSION MATTERS and other relevant articles that may help you).
What makes things even worse is when you have a history of repeated traumas. Perhaps you experienced childhood abuse, and then in adolescence you were raped or bullied in school, and then other things happened in life, and then...you went to Route 91 to enjoy your life and almost died. There are two big words we (shrinks, or “wizards” as we are called in the military world) use to describe the formation and evolution of our thought process. The first word is assimilation. This describes the scenario above. You learned early in life the people cannot be trusted, the world is a dangerous place, and you are worthless. As life continues each trauma serves to confirm (in your mind) that these beliefs (which are quite extreme and not likely completely accurate) are true. They become your truth. Unfortunately that truth makes you perpetually sick.
The second phenomenon, while a little different, lands you in the same place as the first. That word is overaccommodation. This describes a scenario in which perhaps you had a more normal childhood and you learned that overall people are good, can be trusted, you are cared for, and you’re a worthwhile human being. Then you experience a trauma in adulthood (or later in life), perhaps combat, perhaps a rape, or Route 91 on Oct. 1, 2017. Now you have made a complete 180 degree shift in your worldview and believe that people cannot be trusted, will likely harm you or your loved ones, don’t give a shit about you, and you have begun to question your own self- worth (because of course you blame yourself for not doing more during the shooting, etc.). And despite your healthy past, you have rigid beliefs about right and wrong, and perhaps you also have a very rigid view of your own control over your life (we call that “internal locus of control”). In either scenario we end up in exactly the same place.
So what do we do about this? Well, we challenge these thoughts that are not likely serving us well. We take these thoughts into a virtual courtroom and force ourselves to be accountable for them. We make a decision that we are not going to think things that we cannot provide evidence to support (because that would be like saying you’re okay walking around calling the world flat when there is ample evidence that the Earth is round). Now, if you want to be that guy, you have that choice. But it may cause you significant distress in your life because you will constantly find that the world around you contradicts your erroneous belief.
SOLUTION: Write down a belief that you have been telling yourself recently (that continues to make you sick). Then imagine that a friend or loved one is telling you these things. How would you respond? Will you feel the same way about this situation in 10 years? (Refer to HOW TO CHANGE UNHELPFUL THINKING for more detailed tips on challenging unhealthy thoughts.) Would you say such unkind things to your friend? Would you lack compassion for your child or spouse as you do for yourself?
THE BOTTOM LINE: Regardless of how long you have been dealing with trauma, or when or where or who it came from, it can be changed. We have the power to change our thoughts and our belief systems at any point in our lives. We have the power to change our story. And at the end of our lives, all we have is our stories. We can tell the stories of our lives in such a way that they serve us well because they are balanced, fair, compassionate, and accurate. Or we can choose to tell the stories of our lives in such a way that we perpetuate our depression, anxiety, and trauma symptoms. We don’t have a lot of power in this world and can ultimately only control our own thoughts, feelings, and behaviors (i.e., our buckets; refer to DR. GHAED’S BUCKET RULES). At the end of the day it’s your choice how you spend your focus, energy, and time, so choose well.
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