Saturday, November 26, 2011

The View From Here

Here is the part where I tell you that the story so far has just been setting the scene, and now I'm about to turn around and start walking again and take you with me, still on the road out of here but nowhere near any recognizable landmarks. Nowhere near home.

They say it's possible to resolve PTSD with the therapy I'm doing. It feels like it might be. It also feels like whatever resolution that may come won't be coming for a very long time. It took me 20 years to get here. It will take more than a couple of months to get out.

This journey of mine often reminds me of the Vietnam Memorial in Washington DC. Have you been there? I saw it once about 10 years ago, and was completely unprepared for the impact it had on me: it was a deeply visceral experience long before I felt any personal connection to the metaphor it holds.

The wall starts low at each end of a long, sloping walkway, rising up beside it like a curb. It is made of black, reflective stone. You can see yourself reflected in it. I think this is part of the point.

The top of the wall remains level, while the walkway angles downward, bringing you inexorably lower, the black slab rising higher, higher, to your waist, your shoulder, above your head, beyond your reach on tiptoe. The walkway pulls you into the blackness, leading you downward, not letting up.

Printed on the wall, of course, are the names of the fallen. They are listed chronologically by year, so you can see quite literally how the violence progressed from relatively few casualties at the beginning of the conflict to thousands of lives lost in the thick of it. And it just keeps coming. The wall gets taller, begins to dwarf you as you move. And you keep walking, down, down, into the black, and that list of names keeps getting longer, and by the time you get to 1968 you're drowning in it, drowning in death and loss and helpless to stop it.

And then you reach the lowest point of the walkway, with the top of the black wall 10 feet above and the names piled on top of each other out of sight, and you notice that you've turned a corner, the ground has tilted upward and you're headed back to the light, and that's where everything shifts to a new kind of horror. 

Because even though you know, from your safe perspective, that the tide had turned on the war and the deescalation had begun, the names don't stop coming. And you still have to walk past them, all those lost lives, those sons and fathers and brothers and lovers, those men who died and kept on dying even though the course of the war had changed.

You have to keep walking and watch their deaths mark the time. They trickle off slowly,  sickeningly symmetrical to the way they began, but by this time it's really sunk in that each name was a life, a world, a family destroyed. Each name is one too many. Each name is more unbearable than the last, until finally, finally, the top of the wall is once again at your neck, your elbow, your knee, and then, at last, level with the walkway.

I was shocked at how strongly I responded to the Memorial. It remains one of the most vivid, commanding works of art I've ever seen, and I've seen some art in my time. It's also a profoundly moving depiction of the tragedy and horror of war. If you find yourself in DC and need a shortlist of sites to visit, the Vietnam Memorial belongs on that list to the exclusion of many other things that might seem more important. 

They're not.

Anyway. If it doesn't do too much dishonor to the Memorial to say it, I feel like I'm on that walkway in my own head. I have the sense of standing at the lowest point, the point where downward movement has finally, almost imperceptibly ended and the upward slope has not yet begun; the place where you are most aware not only of how far you've come but also of how very far you have yet to go and how much more you'll have to endure along the way.

Recovery of this kind doesn't always feel like a blessing. It feels a lot more like you've just been robbed of the ability to ignore your own suffering. And being newly aware of it doesn't make it recede. You still have to get up and walk yourself out of the hole, only now you can see, in stark relief, the losses that continue to mount as you go.

I told my husband the other day that it's like being handed a flashlight to light my way and finding out I've been sitting in a closet all this time. At this point, the only difference is that now I can see the walls.

"Being able to see the walls is the biggest change there is," he said. "That means that for the first time ever, you know where you are."

He's a wise man, my husband. And he's right. No matter what else, I know where I am now. It's not where I want to be. And for the first time, I'm confident that what I am doing will, eventually, get me where I want to go.

I just have to keep reminding myself of that simple fact as I begin to put one foot in front of the other, here at the bottom of things, and take my first uncertain steps up the slope, heading out of the darkness and back to the light. 

Saturday, November 19, 2011


So... where were we? Oh, right. Numb arms.

"My arms are numb," I said to Dr. Oz.

"Describe the feeling," she said back.

Damn. Describe the feeling is usually as bewildering a concept to me as translate your favorite novel into Greek. It was one of the reasons I was seeking therapy-- I don't really feel much of anything, ever.

I sat there for a minute, opening and closing my mouth, wordlessly, like a fish, until Dr. Oz clarified. Firmly. "I'm not talking about emotions, here. Forget about emotions. What does it feel like, physically?"

It came to me after a moment. "Numb isn't quite the right word, but it's close. It's like the feeling when your foot first begins to fall asleep, when it turns cold, before the pins and needles. Except it's not unpleasant."

"And where do you feel it?"

"Mostly my right arm. Upper arm, elbow, forearm, wrist." It was spreading as I spoke. "Now my shoulder. Both shoulders. My left upper arm."

Dr. Oz nodded. "Is there a movement that goes along with this feeling? Do your arms want to move at all? Is there a word or a sound that goes along with it?"

I tried to come up with something. Nothing came. "No."

She nodded again. 

"Wait," I said. I was mortified. I felt ridiculous. But there was something. Suddenly, as if it had been there for years and I'd never noticed, there was something I wanted to do. "I want to push something away, like this."  I pushed up and outward from my right side, as if something were there, pressing down on me.

And, weird as it sounds, there was something there; something I could feel physically as well as viscerally. A large, shadowy shape looming over my head, forcing it sideways (that quizzical tilt!), pressing my right eyelid down. My skin prickled, suddenly hyper-aware. 

I could feel the mass as clearly as I could feel the couch under my legs.

If this surprised Dr. Oz, she didn't show it. "What happens if you push it away?" she asked.

I pushed. The mass moved away, but then came right back when I lowered my hand. I pushed again, and again, and each time, it seemed to move a bit further away, and I could feel the pressure lifting. I could breathe more easily. My head sat straighter on my shoulders. I sat there on that couch with my arms outstretched, pushing outward, creating an invisible sphere of space around myself...

...and feeling like a complete lunatic.

"What the hell is this?" I asked Dr. Oz. "What the hell is happening to me?"

She just smiled. "The body knows what it needs," she said. "It could be a sense memory. Your boundaries were compromised in the accident, so the urge to push could just be your body's way of trying to establish them again."

I didn't feel as casual about this... whatever this was. I felt out of control of my body, my faculties. "I feel like this is happening without my conscious consent," I said. "I feel like my body is doing things without my permission."

"We're not dealing with your rational brain, here," Dr. Oz said. "Trauma activates your reptilian brain, the primitive part that controls life functions and autonomic responses. It's at the very center of your brain, surrounded by your limbic system, which controls emotions, and your intellectual brain--the neo-cortex-- surrounds that. Your intellectual brain can't communicate with your reptilian brain directly. The two parts can only communicate by going through the emotional center."

Oh my god, I understand Dr. Oz's explanation so much better after finding this picture. Of course the two parts have to communicate through emotional processing-- the neurons literally have to travel through the limbic system to reach the other side.

So for a dissociated person, whose emotional center has gone offline and can no longer communicate well with the neo-cortex, getting through to the reptilian brain is a hell of a lot harder. This is why PTSD is so difficult to unravel. There are so many layers to the work.

"So these sense memories are my reptilian brain talking?"

"Yes. You've done a lot of work to get to this point. Your reptilian brain is beginning to process this trauma."

"And what's the numbness? Is that part of it?"

"Researchers believe this is your body's way of releasing that trauma energy that got trapped so long ago. It's like... off-gassing. It's letting it go, and you can feel it in your muscles, like it's evaporating through your skin."

I stared at her. That is exactly what it felt like. "So this is what's supposed to happen? Other people have had this happen? Have you seen this before?"

A slow grin spread over Dr. Oz's normally-composed face, and her eyes sparkled. 

"Only on film," she said.

Over the next few weeks, two things began to happen. 

At Dr. Oz's suggestion, I started using some of the arm and chest machines at the gym that allowed me to push against a weight, which was much more satisfying than pushing against an invisible mass on a shrink's couch. It stopped feeling silly and started feeling like I was taking real, physical control over the situation and changing my circumstances through action. And it was working. I could actually feel the space around me growing as the...whatever it was... receded. 

Most importantly, the claustrophobia attacks began to fade. I haven't had one in months. 

The second thing was that the numbness/off-gassing, which happened during every therapy session, began to happen not only then, but whenever I talked about the therapy or the accident with someone else. It was as if it started during a semi-hypnotic state that became easier and easier to enter whenever I sat on Dr. Oz's couch, and soon I could put myself in it just by thinking about the issues we discussed.

I also began to notice that the pattern of numbness changed every time, as well. It typically started at the site of an injury: my neck, my chin or forehead scar, my kneecaps, my hipbone, my solar plexus. And it spread to the surrounding areas, sometimes extending to the tips of my extremities, other times concentrating very strongly in one spot, building in intensity until I was convinced I could see the skin puckering and shifting under the waves of cold fire.

Cold fire. It still comes whenever my body is doing the work it needs to do, nearly all the time, now (still, as always, without any need of input or permission from the rest of me). It feels more active than passive these days, less like something evaporating and more like something being forced out from within at the sites of greatest disturbance. It's like an awakening of dormant motion; ghost impulses trying to compel me to move, to fight, to run, to stop the car.

Right now, as I type this, my body is numb with cold fire from my ankles to the bottom of my abdomen. If I lift my feet to press phantom brake and clutch pedals beneath my table, these prickling muscles are the ones I need to use. 

That's the movement that goes along with the feeling, now: Press. Brake. Stop. Prevent. The body knows what it needs. What it remembers. What it never had time to do in a blinding moment of panic, but knew it needed to do to ensure its survival: 

Press. Brake. Stop. Prevent.

"At the heart of it, that's what PTSD is," said Dr. Oz, some weeks later. "Your reptilian brain is stuck in survival mode, continuously scanning for threat and responding as if everything were life-or-death. Your job now is to convince it it's safe to stop. Part of you is still not convinced you survived."

A puzzle piece fell neatly into place, and I was suddenly very sure of something. 

"Part of me is pretty convinced I didn't."

Saturday, November 12, 2011

Trauma Theory

When last we spoke, my arms had gone numb. I will get back to that, and I'll tell you all about it, but in order for it to make sense I have to talk about something else first. This part gets a little academic but it's really important, so stay with me. There are pictures!

Okay. Remember that non-believer thing I told you about? Yeah, well. Keep it close. Because I am about to tell you about the books that changed my life:

Waking the Tiger: Healing Trauma by Peter Levine, Ph. D., and

Crash Course: A Self-Healing Guide To Auto Accident Trauma & Recovery by Diane Poole Heller, Ph.D. 

Peter Levine is the developer of the Somatic Experiencing method of psychology, which you can read about here, and has created a new mechanism for understanding and treating trauma. His theories have only emerged in the past 15 years or so, so it is relatively new scholarship. Diane Poole Heller is one of his associates, and uses his trauma theory in her book. Levine prefers to call PTSD  "Post-Traumatic Stress Response," rather than Disorder, because he has found through his research that it is a perfectly natural response to an overwhelming event.

But more importantly, he has found that it can be resolved. Often completely.

Levine's work addresses our survival instincts-- the "fight, flight, or freeze" response-- and is based on the observation of animals and their similar, instinctive response to threat. Animals' brains work the same way ours do, and when danger strikes, they either fight back, run away, or, if neither of those seem possible, freeze and brace themselves for the attack. 

Imagine, for example, a deer crossing a road in the path of an oncoming car. The deer looks up, sees the lights approaching, and stands stock-still (the "freeze" response). Yep, the classic "deer in the headlights" moment is a real, instinctive response. 

But here's where Levine found something interesting: once the car has passed, the deer will limp over to the side of the road and collapse, as if dead. After a while, it will begin to shake uncontrollably, and will do that for some time. Then, shaking done, it will slowly raise its head, reorient itself, and then rise to its feet and run off into the woods, good as new.

It turns out that the deer has some innate mechanisms for regulating and discharging the high levels of arousal energy that are generated by defensive survival behaviors. Humans have them, too-- we are born with the same regulatory mechanisms as your average Bambi-- and... well, I'll quote Heller here: 

"[T]he function of these instinctive systems is often over-ridden or inhibited by, among other things, the "rational" portion of the brain. This restraint prevents the complete discharge of survival energies, and does not allow the nervous system to regain its equilibrium. The energy that is not discharged remains in the body, and the nervous system gets stuck in "survival mode." The various symptoms of trauma result from the body's attempt to manage and contain this unused energy." 

When we're faced with life-threatening trauma, our reptilian brains take over and we go into survival mode, scanning for threat, assessing our options, and reacting. This stuff happens at a primitive level-- our "rational" minds are not involved here. When we experience a threat so overwhelming that things seem to go in slow motion-- a capital-T Trauma-- that is happening because our reptilian brain has kicked in and we are suddenly hyper-aware, able to focus on the tiny details of our surroundings so that we can find the way out of danger if it's there.

And then we do what our reptilian brain judges is best. If something is biting us, maybe we bite back. If something is chasing us, maybe we run away.

If headlights come around a blind corner on our side of the road and there's no time to do either of the above, maybe we freeze and brace ourselves for the impact.

So. Here's what normal, healthy nervous system function looks like:
Image recreated from Crash Course: A Self-Healing Guide To Auto Accident Trauma & Recovery by Diane Poole Heller, Ph. D.

Heller again: 

"Under normal conditions there is a gentle rhythm between the two consisting of charge and discharge, When that rhythm is in place, we experience a sense of well-being and life feels manageable."

People who have experienced car accidents often get stuck in the "freeze" response, as I illustrated in my example above. This, using Heller's analogy, is "like pressing the accelerator to the floor, while simultaneously jamming on the brakes, so that the engine is fully engaged but the car can't budge."

This, in turn, can cause your nervous system to careen out of control, like this: 

Image recreated from Crash Course: A Self-Healing Guide To Auto Accident Trauma & Recovery by Diane Poole Heller, Ph. D.

You might look at the diagram above and think it looks extreme. Me, I looked at it and saw the last 20 years of my life explained with a few squiggly lines. I saw the same list of complaints I've been taking to my doctors for the last 15 years, asking "What's wrong with me?" and being told I was just unhappy, just high-strung, just over-tired, just imagining things.

I've been stuck mostly on "OFF" all this time, thinking I was lazy, worthless, made of weaker stuff than other people, when I've actually been fighting the tide of parasympathetic overload. The metaphor, though, is so apt it feels almost literal:

I never had time to hit the brakes that night, but I've been stomping on that brake pedal with both feet ever since.

Tuesday, November 8, 2011

Fast Forward, Part 2

I'll start by saying I'm not a believer.

I'm not talking about religious belief here, although I am not religious and this probably does explain it. I also don't mean "believer" negatively. I just mean that I am, by nature, a skeptic. 

I know believers. I know people who are able to throw themselves into things when they feel passionately about them. Whatever it is that they're into-- and it can be one thing or many things at once-- they go with it, they get excited about it, they commit to it, they nurture it, they evangelize it. They're willing to suspend disbelief. They're willing to give it a try. They're willing to give in to it fully until they're proven wrong.

I am often envious of this quality in others. It seems, from the outside, like such a guileless way to live; such an open, embracing approach to life. In its best applications, it seems so free, so spontaneous, so breathless and joyful and life-affirming. 

This is not the way I work. I need proof. I need research. I need preliminary trials, user review comparisons, observation and evaluation. The scientific method. Time and distance. I need to let things sink waaaay in before I make a move.

What I'm saying here is that no one could be more surprised than me by where this has led, which, if nothing else, lends validity to its effectiveness. I didn't go looking for any of this, and certainly didn't expect it. I am not of the type to accept things at face value. I am definitely not the type to subject myself to crazy-seeming and potentially mortifying procedures, expecting them to work miracles. Got it?

Just so we're clear.

So. I'd been doing EMDR therapy for a few months, and had experienced some of the effects of the technique.

There are different ways of doing it, but the basic principle is that you use a "dual attention stimulus"-- wear headphones that play tones that alternate from ear to ear, or hold little vibrating paddles that alternate, or watch a light box with a point of light that scrolls back and forth-- while focusing on a memory from the incident you're trying to explore. The therapist watches your eye movement while you do this, and stops you when they "stick," indicating a particular kind of brain process, and asks you to talk about what's going on, bypassing conscious processes and getting at what's underneath.

The light box gave me a migraine, so I just used the headphones and paddles. I was not, shall we say, enthusiastic. Buzz, buzz. Beep, beep. What the hell am I doing?!

Headphones and paddles. Super high-tech, eh?
It's a controversial technique. People aren't sure how, or if, it works. I can't speak to the "how,", but I can say that somehow during those sessions, our conversations went deeper, got weirder, uncovered things that I seemed to hold on a more subconscious level.

So, that night in April, my therapist (we'll call her Dr. Oz) and I were talking about a small segment of the night of the accident: the very last moment I remembered before the impact, and then the very first moment I remembered after the impact. I didn't know it at the time, but she was having me focus on the time where my "reptilian brain," the primitive part that controls survival needs and manages the fight or flight response, would have taken charge.

Buzz buzz. Beep beep. What did I remember?

Cold. Dark. The winding mountain highway had been completely deserted for the whole first half of my trip home. It was 1am. I hadn't yet seen a single other car. 

I was heading toward a wide left-handed bend, the first part of a blind S-curve, at about 50MPH. As I hit the curve, another car came into view, heading uphill toward me. 

I was told later that the other car was traveling at least 70MPH. 

The next part happened in less than 2 two seconds: We hit the middle portion of the curve at the same time. The oncoming headlights veered into my lane. I thought they'd move back, but they didn't. They kept on, closer, closer, 20 feet away, 15, 10. 

I jerked the steering wheel to the right. The headlights followed. I immediately jerked back. 5 feet. No time to brake.

Then nothing.

And then...

Everything was orange. Glowing. 

My eyes were closed. I was tipped forward and to the left, my head leaning to the side and resting on something. I couldn't lift myself up. I couldn't open my eyes. Through my eyelids, the world was orange. 

"Just sit tight," a man said from beyond my left shoulder. "Don't move. Just sit tight. We'll get you out."

"Stop for a moment," said Dr. Oz. "Let's check in. What are you feeling in your body right now?"

I stopped. I checked. I was still embarrassed by this question; I never really knew how to answer it. I was opening my mouth to say what I usually said, "Nothing," when all of a sudden, I noticed something strange. 

I looked up at Dr. Oz, and said instead: "My arms are numb."

Saturday, November 5, 2011

Fast Forward, Part 1

There were other things that happened over the next several years-- other symptoms, other events-- that I could link to the accident and see as outcomes.

For example, my body never really recovered. Despite two decades of intermittent physical therapy, chiropractic work, network spinal analysis, yoga, trigger point massage, accupuncture, laying of hands, rolfing, reiki, wiccan spell-casting (let's just say that in the San Francisco Bay Area, there are many, many paths to the waterfall), I still struggle with neck, back, and knee pain that leaves me immobilized at worst, and, at best, in constant mild discomfort and with what feels like the agility of a 75-year old woman. 

I have also suffered from chronic, often debilitating migraines for the past 14 years. They have come at least once a month and last anywhere from one to five days. They didn't start until several years after the accident, but I've always known there was a connection. The migraine pain follows a classic pattern: it begins as tension in my neck and shoulders, then creeps its arms upward over the top of my head and anchors itself above my right eye, in the seam of awkwardly-mended bones that you can still feel if you press your fingers there.

These and other stories, I'll tell later. They sit within a history that is being recast in a different light, and I understand now that there were many, many more symptoms after the accident that I didn't connect at the time. That no one connected. That could maybe have been changed, then, and that are definitely being changed, now. 

So. A lot more to tell, but it's getting hard to talk about without first telling you about what's happening in the present, and how it has led me here. This is not a story about a car accident. It's not a chronicle of loss.

This is a tale of survival.

About a year ago, in September 2010, I decided to find a new therapist. I'd been thinking about it for a while: I'd seen two other therapists in the past 10 years with excellent results. I have struggled with major depression off and on for many years, and while the birth of my twins in May of 2009 had not, as I'd feared, brought on postpartum depression symptoms, I had been noticing some things that needed addressing.

Most alarming were the hallucination-like attacks of claustrophobia I'd been having for the past several months.

I'd be sitting on the couch, folding laundry or watching TV or eating dinner, calm, normal, going about my business, and then in the next instant I'd be FALLING! Down down down a well, a crack, a hole in the ground; light fading above, walls closing in, arms held tight to my sides, trapped, trapped, chest compressing, breathe, breathe, can't breathe, can't BREATHE! 

I'd jolt into hyper-awareness, suck in a gasping breath, I can breathe I can breathe; shoot my arms out from my sides to feel the empty space there, I can move, yes, I can move; plant my feet back on the floor to feel its solidity and bring me back to here, now, and go about the business of doggy-paddling my head back above the murky water of whatever that was.

Away, away, away, I'd tell myself... away from what, I didn't know... and my thoughts would drift back to the laundry, the TV, the babies, the couch.

All this would take place within 5-10 seconds. It was a familiar feeling, familiar fear. It had happened occasionally over the years since the accident, its obvious inception. But in recent months it had gone from happening so infrequently that I could barely remember the previous incident to happening several times a week. And then it was happening several times a day.

It was getting weird.

That, along with that "Girl Who Lived" comment on my Facebook page and the knowledge born of experience that this sort of weirdness and discontent doesn't, in fact, go away by itself, compelled me to finally pick up the phone and make some calls. It took longer than it should have. Things required for self-care usually do, with me.

Turns out there's an explanation for that in all of this, too.

Anyway, when I told my husband what I was going to do, he suggested, not for the first time, that I look for someone who practiced EMDR (Eye Movement Desensitization and Reprocessing, a therapeutic technique used for trauma victims), and that I consider all of these symptoms as offshoots of my car accident all those years ago. I'd thought this sounded just a little too... Berkeley... for me in the past, but the claustrophobia stuff was getting worse and as I hadn't been claustrophobic before those terrifying months after the accident, I figured it made sense to connect them. It was worth a shot.

And get this: the only therapist close to my house who had evening appointments and accepted our insurance was an EMDR specialist.

So I went. Things began as they typically do, and spent the first several months talking about typical stuff, building the relationship, figuring out how to proceed.

And then one night in April, in the middle of a session, something happened.