New York City, NY

Before Complex Trauma was a Diagnosis

Rev. Sheri Heller, LCSW

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Being a seasoned complex trauma therapist in NYC who also specializes in treating narcissistic abuse, makes looking back at my recovery process a particularly somber experience. There is so much clarity in hindsight that I wish was attainable when I vacillated between states of hyper-arousal and numbing and could barely identify a feeling or acquire the slightest grasp of who I was. With sorrow, I recollect a lost young woman beset by flashbacks, process addictions, self-loathing and traumatic loneliness.

While I am grateful that my extensive history of healing has afforded me a comprehensive understanding of complex trauma that I can now pass on to the men and women who seek me out for treatment, the excruciating despair I endured is a reminder of how challenging it was to persevere prior to Dr. Judith Herman’s introduction of the diagnostic term Complex PTSD. Similarly, a form of relational trauma I endured known as Narcissistic Abuse Syndrome, or what some refer to as Echo Personality Disorder, was not yet popularized by Dr. Craig Malkin.

It wasn’t until 1992 in the Journal of Traumatic Stress did American psychiatrist Dr. Judith Herman publish Complex PTSD: A syndrome in survivors of prolonged and repeated trauma. Here Dr. Herman proposed a new diagnosis to capture the array of symptoms and difficulties observed in adult survivors of childhood trauma, prisoners of war, victims of domestic violence, religious cults, sexual abuse, kidnapping and human trafficking. Herman’s work elucidated how trauma is a penetrating wound and injury, which threatens one’s life and arrests the course of normal development by its repetitive intrusion of terror and helplessness into the survivor’s life.

For survivors such as myself, the diagnostic recognition of complex trauma validated that my history of unabated child abuse and neglect resulted in developmental disasters and the fragmentation of my overall personality. It affirmed that under these conditions my identity formation was stymied and a reliable sense of independence within connection was ruptured. It explained that dissociation can be so severe that a fragmentation of the personality can result in the emergence of altered personalities. Even complete amnesias may occur.

Having a blueprint to my madness afforded me a modicum of solid ground. It offered me a comprehensive causal trajectory that explained my suffering and compassionately affirmed my plight. This realization had a tremendous impact on my recovery process and my chosen career as a complex trauma therapist.

Yet at eighteen when I desperately sought help, all I knew was that I was a terrified mess. By the alarmed expression of the intake worker at Bellevue hospital, it was obvious that she concurred.

My entree into long-term therapy, although well-intentioned and ultimately reparative, did not contain Dr. Herman’s theoretical framework for understanding what I was up against. Accordingly, when I was finally paired with a psych intern my inability to even allow for a therapeutic alliance to unfold was misconstrued.

Devastated by a failed relationship with a young man who I unwittingly fell in love, I had no words for how that immediate loss ignited paralyzing numbness, alcohol abuse, crippling self-hate and fragmentation. Instead, I enacted with my therapist what occurred with my ex-beau. As insatiable as my longings for love were, I simply did not feel worthy of receiving. Hence, I obstructed my therapist’s efforts to care for me.

Rather than conceptualizing my lack of volition and engagement as indicative of complex trauma, I was viewed once again as a source of frustration. Queries as to what I wanted, needed or felt were met with silence. Truth is, I hadn’t a clue as to who I was and what I was entitled to in life. Furthermore, my neurobiological response to trauma elicited an ‘unspeakability’, as the horrifying events I endured could not be organized on a linguistic level (Bessel van der Kolk).

My adaptive attempt at preservation consisted of being as invisible and insignificant as possible. I was never allowed to exist, other than to assuage the demands of my abusers. In the service of survival, I conformed to those expectations. That this pattern was indicative of trauma bonding (aka Stockholm Syndrome) initially eluded my therapist and me.

Herman conveyed in her seminal book Trauma & Recovery that survivors of complex trauma, “have such profound deficiencies in self-protection that they can barely imagine themselves in a position of agency or choice. The idea of saying no to the emotional demands of a parent, spouse, lover or authority figure may be practically inconceivable. Thus, it is not uncommon to find adult survivors who continue to minister to the needs of those who once abused them and who continue to permit major intrusions without boundaries or limits. Adult survivors may nurse their abusers in illness, defend them in adversity, and even, in extreme cases, continue to submit to their sexual demands.”

This attachment template and core interpersonal patterns born of traumatic abuse were often confused with hostile indifference, passive-aggression or viewed as evidence of a personality disorder. Sometimes my fawning passivity might be regarded as being overly ‘accommodating’ or outright manipulative.

As I explained to journalist Ajah Hales in her Vice article Fight or Flight’ Are Not the Only Ways People Respond to Sexual Assault,” a victim may try to flatter, bargain with, charm, or otherwise pacify their assailant in order to redirect and eventually escape the situation, or to lessen the damage done, should escape be impossible. When it feels futile to fight, victims may resort to the fawn response in an effort to assuage the perceived threat. By behaving in a servile, obsequious manner, the victim of sexual assault achieves a locus of control.

Unfortunately, this strategy became a way of life for me, as it is for many survivors of systemic abuse. Given that complex trauma is rooted in incessant attachment injuries, my attempts to negotiate adult relationships were hampered by the maladaptive psychological defenses formed in childhood.

Like an insatiable junkie, I yearned for and compulsively sought a fleeting sense of connection. Even though a debilitating crash in which I was swallowed up by emptiness and shame accompanied each hollow pursuit, the random hits of relational stimulation that temporarily numbed unbearable pain, kept me wedded to this addictive cycle.

Tragically, it took ages to understand that my compulsive reckless pursuit of love was indicative of an urgent longing for integration. I needed healthy corrective attachments and positive mirrors to fulfill dependency needs, and most importantly to compassionately repair a self that was insubstantial and broken.

Ironically, although my instinct to procure attachment was correct my rapacious need for protection and love coupled with fears of abandonment and exploitation obstructed the establishment of safe and appropriate boundaries.
For much of my life patterns of intense, unstable relationships occurred, in which dramas of rescue, injustice, and betrayal were enacted. I repeatedly put myself at risk for victimization.

Nevertheless, I stayed the course and hobbled together a treatment plan of humanistic therapy sessions, twelve-step groups, bodywork, and John Bradshaw’s inner child work. Along with my immersion in the arts, academia and my love of travel, these modalities helped with managing debilitating symptoms and defining a historical narrative. These efforts slowly allowed me to glean a distinct awareness of myself.

When I attained the ego strength to face the profound level of despair that would have shattered me in childhood, I sought a complex trauma therapist who could guide me through a process referred to as complicated bereavement. Complicated bereavement, a crucial stage in recovery for survivors of complex trauma, constructively reframes a history of systemic victimization so that eventually the past can be mourned and parsed out from the present. Complicated bereavement assists with coming to terms with what is reparable and what is not so that life-affirming possibilities and ambitions can unfold.

Fully facing what was done and what the traumas led me to do under extreme circumstances unearthed crippling hate and shattering levels of grief. Constructively navigating these memories unleashed a mourning of the loss of my integrity, the loss of trust, the capacity to love, and the belief in a ‘good enough parent’. In order to plumb these depths I had to rely on basic tools and resources that fostered safety, regulation and containment.

Through this mourning process, I was able to reevaluate my identity as a ‘bad’ person and feel worthy of relationships that allowed for authenticity and nourishment. Over time I came to experience my history of trauma as a part of the past. This shift afforded me the task of rebuilding a life in the present characterized by possibility and hope.

Naturally, in hindsight, it was all worth the struggle, as I never would have attained peace of mind and the quality of life I have now if I didn’t somehow find within me the courage to embark on a journey of recovery. Still, I sincerely doubted the attainment of these rewards while I was going through it, especially prior to gleaning a clear understanding of the machinations of complex trauma.

Although in the late 1800’s neurologist Jean-Martin Charcot and his students Pierre Janet and Sigmund Freud pioneered the study of trauma-induced dissociative phenomena in the female hysterics they treated at La Salpêtrière hospital, gendered politics silenced the public recognition of the incest and rape trauma tormenting these women. Essentially, psychological trauma was recognized by these pioneering clinicians and yet the maltreatment of children, in particular sexual exploitation, was largely ignored as a societal problem of the Victorian era.

In fact, early on in his career, Freud attributed his female patients' symptoms to repressed memories of sexual abuse trauma. That these symptoms were so prevalent throughout Viennese society meant that child abuse was rampant. To dodge scandal and political suicide he discredited his findings of sexual abuse, and instead revised that these traumatic memories were in fact unconscious fantasies.

Even today with the United States having one of the worst records among industrialized nations, losing on average between four and seven children every day to child abuse and neglect the collective discrediting of child abuse continues to interfere with recognizing complex trauma as a public health issue.

Moreover, The Center for Disease Control’s Adverse Childhood Experiences (ACE) study (Felitti M.D., Vincent, J., Anda, M.D., Robert, F., Nordenberg, M.D., 1998) concluded that “child maltreatment was the most costly public health issue in the United States, calculating that the overall costs exceeded those of cancer or heart disease, and that eradicating child abuse in America would reduce the overall rate of depression by more than half, alcoholism by two-thirds, and suicide, serious drug abuse, and domestic violence by three quarters. It would also have a significantly positive effect on workplace performance, and vastly decrease the need for incarceration.”

Nonetheless, mental health professionals still do not routinely enquire about childhood sexual abuse during mental health assessment in acute mental health settings (Hepworth I, McGowen L) and trauma psychology is not currently an integral component of the standard curricula in graduate-level education.

Undoubtedly the ability to diagnostically assess and treat complex trauma is predicated on a comprehensive understanding of the presentation and needs of a trauma survivor, as well as the approaches and techniques specific to trauma therapy. Therapists lacking proper training may erroneously emphasize a character pathology framework, failing to distinguish symptoms rooted in systemic childhood abuse and attachment injuries from relational volatility rooted in the absence of a coherent sense of self. This oversight can result in a reduction of psychiatric symptoms but precludes the processing of traumatic memories so that full integration and healing can occur.

Indeed, due to the variable nature of complex trauma and the presence of co-morbidity I was on the receiving end of a smorgasbord of diagnosis and interventions, even when complex trauma gained attention. It was not uncommon for clinicians not versed in treating complex trauma, to mistake the vacillating symptoms of dissociation and flooding for bipolar disorder. Even with the World Health Organization including complex trauma in the International Statistical Classification of Diseases and Related Health Problems (ICD-11) in 2018, c-PTSD is still often confused with bipolar disorder, borderline personality disorder, sundry mood disorders, and even ADHD.

In closing, despite the vast evidence of the devastating effects of child abuse on mental and physical health, complex trauma continues to be mitigated in our diagnostic systems and in our primary treatment paradigms.

This leads me to question our collective need to deny culpability in predatory caregivers, and our tenacious belief in group narratives that engender false hope and uphold a morally depraved social order. It seems to me that deeply entrenched fears that not all things in life can be transcended or absolved compel us to reject surreal forms of brutality. After all, we want to feel safe and for life to be predictable. It is disturbing to consider the vast repercussions of our refusal to accept that the most insidious cause of mental illness is humans themselves. It is this stance of denial that further ensures that predators have free rein to abuse, while victims of complex trauma continue to suffer in silence, hindered from accessing potentially life-saving trauma-informed treatment.

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As a survivor (and thriver) of complex trauma and a seasoned therapist specializing in treating complex trauma, narcissistic abuse syndrome and addictions, I am intent on creating content that affords informative insight, hope and healing from psychological disorders. I aim for my creative content to assist readers with tapping into the resiliency of the human condition while recognizing the countless challenges of being human.

New York City, NY
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