Trauma sticks - and the sticks beat to their own drum

Here are two case studies, names have been changed and none are from the UK. 

Case study one:

Part 1: when aged 18

There were identical twins, Nella and Paula. They looked the same, had the same backgrounds, same upbringing, same education and had both been sent to help an NGO in Africa for a summer. 

Nella arrived feeling anxious, thinking about all the things that could go wrong, all the unknown people and unknown situations she would face. She's never been in this environment before. It's hot, dusty, nasty flies everywhere; the locals look strange and the other volunteers even stranger. So many different languages. People look at her, open-mouthed as she gazes around like a rabbit caught in headlights. The second she can, she's going to take some medication from her bag to feel better. What are the words in her head?

“I can't cope with this.”

In her mind's eye, she visualises catastrophes to match. 

Her twin sister, Paula, is the exact opposite. To her, the new environment is interesting because it is unknown, as are the people and she can't wait to discover what new things she can learn. She's already caught the eye of locals and volunteers with her smile and open eyes, rather than open mouth. Everyone is speaking English, just with different dialects and accents, and they all seem to be working well together. The second she can, she's going to drop off her bags and go say hi to a whole bunch of them. What are the words in her head?

“This is brilliant!”

In her mind, happy visualisations of working in a team, to help the locals.

What is different between Nella and Paula? Physically nothing. The only difference is their approach, to not just their new situation but to life. Nella has already resorted to medications to help her cope with things but what exactly is it that stops her being relaxed like Paula? In Nella's case, it is intrusive thoughts, which can be traced back to a seemingly innocent yet psychologically traumatic event when they were almost three years old.

Part 2: when aged 2 and a half

While on holiday, their family was picnicking. Nearby was a stream and Nella challenged Paula to a bridge-building competition. Their parents agreed to be timekeepers and gave them 2 minutes to complete the task. It was fun rushing around to gather long sticks and lay them over the stream, both giggling as they did so - smiling parents watching on. 

“Time.”, their parents called.

Obediently, they both stopped and stood back to admire their work, bridges almost identical in size and structure.

“Can you cross them?”, their parents asked.

“Sure.”, they both answered, throwing huge smiles at each other.

“10 seconds. Ready, set, go.”, said their parents and, on 'go', they both squealed with delight and ran over their respective stick bridges to the other side.

Before Paula got to the other side, she heard a shout from Nella and turned to see what had happened. Nella's bridge had collapsed. She was standing in the middle of the stream, the skin on her shins scraped by the wood where she had fallen through. Her parents laughed, trying to make a joke of it but Nella's legs were hurt and now her ego was too. She felt a failure, felt she was being mocked. Paula's bridge still looked as good as it had before but hers was broken and she had wet, cold feet too. A total disaster. 

Still trying to make a joke of it, their parents came over to help her up and dry her off. For years to come, it would be a standing, family joke about how Nella shouldn't try building things. For them, it was an innocent, playful joke, which Nella felt forced to smile at, but for Nella, every time they said it they reinforced her negative feelings from that day. Feeling both useless and inferior to perfect Paula. 

No one had ever gone to see why Nella's bridge had broken and Paula's had not. If they had, they would have realised it had nothing to do with her bridge building but simple misfortune - grabbing rotten sticks. She wasn't even three years old so had no idea about good or bad wood. Yet the aftermath of that event, innocent entertainment for the rest of her family, went so deeply into Nella's psyche that she began to focus on other negatives, even when there were none; telling herself, more and more: “I can't do it. I'll fail. I'm not good enough.” 

That simple, breaking-bridge event, had started a change that impacted her entire outlook on life.

No matter how innocently they may occur, even seemingly small, insignificant events in early life can seed a world of trauma-based intrusive thoughts, that can stick in a child's subconscious and remain into adulthood.

Case study two:

Alina is 11, and her sister Marnie is 17 - they have been close since the day Alina was born. Seven years earlier, when aged 4 and 10, they became even closer after a major, life-threatening event. Their dad's car was blown up by a bomb, outside their house. Imagine their terror to be woken from sleep like that, their home under attack. Would there be another explosion? Could their house be next? 

Thankfully nobody was in the car but their parents were too busy running around, calling the police and looking out for further attacks, to sit with them. So they sat with each other, hugging in fear; big-sister Marnie the closest support Alina had and she was desperate for it, her overwhelmed 4-year-old brain seeking nothing but safety and refuge in Marnie's arms. It was a shared trauma but they emerged from the event in different ways.

Trauma is a trapped shock that leaves a very black-and-white 'bright light' impact on the brain. Think of it like an old-fashioned camera flash going off – if you close your eyes you can still see the flash afterwards. What were their coping mechanisms on that terrible night? Alina sought refuge in the safety of her big sister's arms. Marnie deflected from the traumatic event by focusing on caring for Alina and helping her fears, while ignoring her own. Where are we seven years later?

Both girls have been in therapy, off and on, for several years. It is not trauma therapy so their trauma remains, as do the very same coping mechanisms they used that night. Alina still wants to glue to Marnie to feel safe and secure. Marnie still wants to care for a vulnerable girl though, now 17, her needs are for a more adult version of Alina. Her replacement is Rachel, a girlfriend in need, her own age. Looking after Rachel meets her coping mechanism needs from that night and makes her jumping up and down happy whenever she's going to meet with Rachel, feeling her purpose in life is fulfilled. Rachel, like Alina before her, is very grateful for Marnie's love and support and their relationship works very well. 

Where does this leave Alina? She has no other Marnie to glue to. For her, the coping mechanism needs have been torn away. She suffers from depression and sadness, is school avoidant and glummer than glum. Her mother, another older female she can trust, is her surrogate Marnie, so at home, after school hours, her coping mechanism can be re-engaged and she smiles again, at least for a while. Going back to school breaks it, for her mother can't come too and, even though Marnie can for a while longer, Alina still feels abandoned. She suffers an endless cycle of desperate hope Marnie will come back, mixed with the knowledge Marnie is almost entirely focused on Rachel. 

Sadly, like so many, neither Alina nor Marnie have dealt with their trauma or learnt to internally validate themselves. Marnie displays the exact same coping process, only now via Rachel instead of Alina. Alina, coping mechanism floundering, finds herself floundering - unable to find another Marnie. Unable to self-validate, she still suffers from depression and mood swings, including towards Marnie and Rachel. She feels ever more abandoned, insecure and unloved. This is the power trauma can have over us. 

Trauma doesn't just stick, it keeps on hitting us like a stick, in a rhythm of its choosing. It won't stop beating until it is dealt with. As adults, we can all too easily forget that what seems small or temporarily upsetting events to our adult minds, to the young and vulnerable, can become emotional, life-changing and potentially life-long traumas. 

Neuroscientist Dean Burnett, in his brilliant book 'The Idiot Brain', makes the point: “Feeling in control makes most people feel secure and safe, It doesn't matter how much actual control we have.”

On the Holmes and Rahe stress scale, ranging from 11 to 100 LCUs, divorce scores 73, death of a spouse scores 100 and a child woken from sleep by the blowing up of a parent's car outside their house will score off the scale, as will the murders and bombings around children in war zones.

In terms of therapy, this illustrates the importance of protecting children not just from physical trauma but from feeling less than in situations we adults can just shrug off. While trauma and intrusive thoughts are invisible, the manifestations that follow are not. As therapists, we ignore this at our clients' perils. 

If we can find their beating stick, no matter how small it might appear to our adult brains, we have a chance of turning it from wood or iron to cotton wool. The causal memory from overwhelming to just a memory, that no longer hurts when it hits.