Most of us have heard about Post-traumatic Stress Disorder and many of us associate PTSD with the military and experiences of being in combat. Post-traumatic stress disorder indicates a psychological response to an acutely traumatic situation. It was coined and popularized in the 1970s after veterans were returning home from their deployments in Vietnam exhibiting the effects of the extreme stress that they’d been under. This stress was often the result of a moral injury. I’ll be diving into moral injury in an upcoming blogpost, so stay tuned for that! For now, let’s dive into CPTSD.
Complex post-traumatic stress disorder, which is also known as slow trauma, complex trauma, or developmental trauma, is trauma that occurs over a longer period of time, and happens during our childhood. It is a more recent development in the psychology world and in 2015, Pete Walker released his seminal book Complex PTSD: From Surviving to Thriving.
In his book, Walker takes us into the world of this all-too-common phenomenon and clarifies what it is, where, when and how it happens, and what we can do to heal.
CPTSD is a more severe form of post-traumatic stress disorder. – Pete Walker
CPTSD is often caused by growing up in a severely abusive and/or neglectful family system. This includes abandonment and abuse on a physical, emotional, verbal, and/or spiritual level. While many adults who have CPTSD were physically hit/beaten in childhood, that is not a mandatory factor.
The core wound in CPTSD is emotional neglect. This occurs when there is no safe adult to turn to for comfort or protection in times of real or perceived danger.
Five pernicious qualities of CPTSD are:
triggers that create intense emotional overwhelm/emotional flashbacks
a vicious inner critic
Here’s a list of factors that, if present during your childhood years, may indicate your possible exposure to that Complex PTSD:
extended periods of physical or sexual abuse
ongoing verbal or emotional abuse (this includes being intimidated, threatened, shamed, or name-called)
being treated with contempt by a caregiver (with denigration, rage and/or disgust)
emotional neglect (not providing support, safety, education or advocacy during intense emotional experiences)
feeling that you didn’t have a voice, or that your voice/values/desires were not honored by your caregivers
your attempts at healthy self-assertion were met with resistance or retaliation/being called “selfish,” ignored, or punished by a parent
The good news, as Walker states, is that:
CPTSD is a learned set of responses, and a failure to complete numerous important developmental tasks.
In other words, CPTSD is something we can heal from.
If these words resonate for you, and you are ready to heal, reach out. Let’s get it going.
As a therapist and as someone who has had my own experiences with anxiety and depression, I’d say that Gulman nails it with his descriptions of both. He deftly brings humor and levity to the most serious of topics: that depression in extreme cases ultimately leads to suicide.
Gulman ends up back at his childhood home with his mother after a particularly pernicious episode with depression that zapped his ability to seek out a new apartment in NYC after his lease came to an end. He talks about how his depression started in childhood and explores his young life as the only child of a single mother growing up in Massachusetts.
The disparity between his own experience and his mother’s recollections are stark and, by today’s standards, of concern. His mother refutes any suffering on Gary’s part, emphasizing how his annual school photos portray “such a happy boy.”
One illustration he used highlighted the difference in the internal thought process between not being depressed and being in the thoes of depression. While a depression-less state allows us to smile at a beautiful sunset, depression can cause us to project our own misery onto the sun with thoughts like “yeah, you’re giving up too, I don’t blame you.”
Gulman talks about his long journey with medications and his rationale for taking them is compelling: any side effect is better than the crippling effects of major depression.
Braving the murky territory of psych-wards and electro-convulsive therapy (ECT), Gulman speaks to his own experience and skillfully normalizes and de-stigmatizes both.
He also confesses to attending years of therapy and how he feels it has benefitted him. He articulates his struggles sharing with friends and colleagues his own mental health challenges for fear that it would make them uncomfortable. This is both relatable and unfortunate.
What I love most about this piece of work and admire about Gulman is his vulnerability in pushing this conversation about mental health further forward. So many creative people in the arts deal with mental health challenges and often we find out about it too late.
Let’s keep talking about it. Mental health awareness matters.
This past week I read The Covert Passive Aggressive Narcissist by Debbie Mirza, a life coach and author in Colorado. I have a significant amount of experience with covert narcissism and feel that this work is a solid exploration of how this mental health disorder looks in relationships.
Covert: not openly shown
Passive Aggressive: displaying behavior characterized by the expression of negative feelings, resentment, and aggression in an unassertive, passive way
Mirza states “the covert narcissist hides their dark attributes because they want people to like them.” In overt narcissism the assumption is often already made that others like, admire, or feel jealous of them.
Some additional important differences are:
while not empathic, covert narcissists can appear this way as they have learned how to act empathically
they often appear to be humble, kind, or generous (as with other types, image is very important to them)
while they tend to lack long-lasting friendships, they are rarely without a partner
they give you subtle messages that cause you to question yourself – over time this leads to a tremendous amount of self-doubt as you learn to ignore your own intuition
The Three Phases of Relationship with a covert passive aggressive narcissist are also explored in depth, and she provides a lot of clear examples of what these relationships look like, sound like and can feel like through each phase.
A few additional take-aways for me were the tendency for the covert-PA narcissist to project their own issues onto others, instead of taking ownership and accountability for themselves, and the fact that they “have no interest in making this a great relationship” as exemplified by their inaction when conflict arises.
Gaslighting, flying monkeys, hoovering, intermittent reinforcement, deflection, blame, minimization and other control and manipulation tactics are also well defined in this book. Control and manipulation are the names of the game with a covert passive-aggressive narcissist.
In her last chapter she offers a few suggestions on how to heal after such a relationship and she stresses the importance of boundaries, getting support, and coming home to the wisdom of your own being. This is often a process, considering that these relationships tend to cause a significant amount of self-doubt and uncertainty about trusting oneself.
I highly recommend this book.
If you have been in a relationship with a covert passive aggressive narcissist or think you might be in one, reach out for support today. These individuals can cause a significant amount of psychological, emotional and physical suffering in their victims.
I recently wrapped up my reading of Kristen Neff’s book Self Compassion: The Proven Power of Being Kind to Yourself. I thoroughly enjoyed the book and found myself introducing my clients to ideas and exercises that I read about as I went through the book. Neff has a gift for writing and I particularly liked the way she combined her research with her personal experiences in a way that made much of the book both relatable and rooted in the scientific process.
One idea that seems to be coming up for me repeatedly, and which this book reinforced, was the importance of shifting from a “we’re all incredibly unique” mentality to a “we are all largely alike” mentality. Perhaps as a result of the time in which I was raised, I have always believed that we are all different, but I am coming to see the truth and value of the fact that we are really all similar. We all want to be happy, we all have skills at which we excel, we all deal with the same landscape of emotions, and we all must contend with life’s challenges on life’s terms. We all are wired for connection and tend to feel happier when we are in a state of connectedness, and we suffer when we feel disconnected from others. When I first came across this idea, I cringed, but the more I am exposed to it the more it makes sense to me: we are not really that unique after all.
Another idea that Neff explores is the myth of self-esteem. Once known as the holy grail of success, Neff accesses the inherent flaws with the pursuit of self-esteem and espouses the idea that self-compassion is a far worthier pursuit (a sentiment with which I agree).
Many of the exercises are relevant to myself and those with whom I work in my private practice. Anyone who struggles with a strong inner-critic or inner perfectionist would benefit from some of the tools Neff shares. My personal favorite is a manta to be utilized in moments of suffering and it goes something like this:
This is a moment of suffering.
Suffering is a part of the human condition.
May I be kind to myself in this moment, in the face of my own suffering.
What can I do, in this moment, to express care and compassion for my own challenging experience?
I highly recommend this book. Have you read it? What did you like?
I am currently in the process of reading Kristen Neff’s book Self Compassion and just came across, seemingly for the millionth time, the reference to “putting on your own oxygen mask first.” In case you haven’t heard this frequently used in-flight instruction demonstrating the importance of self care, I am here to break down why it is simply the greatest psychology metaphor of all time.
Psychotherapy and Exploring The Self
So much of what we psychotherapists are doing with our clients is exploring The Self: the self as separate from family of origin, from partners, parents, friends, children, and siblings. So often, the reasons that elicit the need for psychotherapeutic services are relationships gone wrong. Early childhood trauma, parents that were too self absorbed or uneducated on the basic needs of infants and young children or the lifelong impact of not meeting those needs, and unsatisfying or abusive adult relationships often leave individuals feeling confused, stuck, and anxious and lead people to seek help.
As we look at what has transpired within these relationships, and how they have become sources of pain, we also begin to look more closely at the self of the person who has sought our help. Together, we begin to inquire. Who is this person? What are the needs of this separate self?
What we often find is that the self has needs, desires, and ways of being that are distinct and unique. Taking good care of that separate self is one of the chief tasks of adulthood. Hence, the analogy.
We, as adults in relationship with others, must become good stewards of our own experience so that we can, in turn, be good caregivers to others.
An Experiment for Cynics
Don’t believe me? Here’s an experiment: for the next week, avoid doing anything simply because you enjoy it. Commit only to doing things that are in the service of others: your kids, partner, friends, colleagues, etc. Notice how you feel at the end of that week (if you can make it that long!). Exhausted? Irritable? Angry? Resentful?
How are the relationships themselves? Strained? Tense? One-sided?
When we care for others at the expense of caring for ourselves, ultimately, relationships suffer and everybody loses. A burned-out, overworked and anxious employee is hardly in a position to offer the same level of clarity, creativity and critical thinking as someone who has a balanced work/play/rest lifestyle. An exhausted, energetically depleted mother can not give the same level of presence and empathy to a struggling child as a mother who is rested and well cared for.
Back to The Metaphor
The instruction given at the beginning of every commercial flight states “in case of an emergency, put on your own oxygen mask first before assisting someone else.” This clearly illustrates how caring for yourself is paramount in order for you to truly care for others. Breathing is a symbol for life, for being. Inhabiting a human body requires regular care and maintenance: rest, food, water, touch, movement. If we don’t tend to the needs of the body we get sick. Tending to the needs of the psyche/soul also sustain life, infusing it with meaning and understanding, allowing us to make connections, grow and evolve. Taking a holistic perspective requires that we view ourselves as consisting of many parts: mind and body; soul and spirit.
As adults, we afford ourselves and those in our care the opportunity to experience true generosity and abundance when we are able to tend to our own metaphorical gardens. Otherwise we run the risk of showing up for relationships empty handed, without resources and craving that someone else will fill us up. Not only can this lead to disappointment by expecting from others what they may not be able to give, but this caring for ourselves also serves as a protective function. When we do show up for relationships in desperate need for affection and attention, we open ourselves up to victimization by predators who may give us something, but ultimately take more than what’s offered.
Essentially, this metaphor encourages us to help others. It stresses the importance of being able to be there for others in their time of need. But who are you going to help if you can’t breathe?
With the demands of domestic life we may lament our lack of time for formal spiritual practice. Let’s not forget, though, family life, if we exploit it, is spiritual practice of the most valuable kind – Sarah Napthali