Jim did find respite, or more accurately, distraction, on the job. He worked tirelessly as an auto mechanic. He loved cars almost as much as he loved motorcycles, and he put in twelve-hour days routinely. He knew he was shortchanging Michael, but he rationalized his long work days.
He found other distractions, namely motorcycle riding and drinking binges. When Jim resided in the darkest of places, he combined the two. Something about riding at 110 miles per hour (with Johnny Walker Red as copilot) could make Jim Jr. and Kevin all but fade away. He also recognized how dangerous this behavior was and how he was half hoping that a fatal accident might obliterate his emotional pain.
Jim settled on alcohol as the best alternative to suicide—that and a compulsive work ethic. He did as well as he could with Michael, participated in Boy Scouts, and even co-managed his little league team one year. But there was no ice skating, ever.
I began working with Jim forty-five years after the tragedy. He was suffering from chronic depression, with symptoms like “anhedonia” (deriving little joy from activities that once provided happiness and contentment) and dysphoria (low mood). He also was afflicted with insomnia—four uninterrupted hours was a good night’s sleep—and he was tortured by nihilistic or “what’s the point in life?” type thinking and horrible self-contempt (“They died on my watch!”). There was also a generalized anxiety—Jim called it his racing motor—and chronic fatigue. With more than just symptoms of depression and anxiety, Jim met the criteria for a common psychiatric diagnosis known as Post-Traumatic Stress Disorder (PTSD).
Despite his best efforts to run away from the past, Jim was haunted by intrusive recollections of the traumatic event, “Just how many times do I have to see that helpless look on Kevin’s face before he plunges into the water?” There were also flashbacks of the headfirst dive, the frantic calls for help, and the sleepless nights before the bodies were found.
Like almost all PTSD sufferers, Jim avoided any reminders of the tragedy; no New York Rangers season tickets, no desire to be around families (since his was irretrievably broken), no anniversary of the death, no birthdays, no mention of the boys, and for God’s sake, no talking about the event! Holidays were intolerable, and family members or friends who were likely to offer consolation or “lame advice” were to be avoided at all costs. “Ruth could see ’em if she wanted to, but I wasn’t going.” Avoidance also meant moving to another town, away from the neighbors who knew him and knew what had happened, away from his church, and away from that godforsaken river. And avoidance was the reason Jim drank himself to oblivion. Before the accident, he had been a social drinker; afterwards, he employed the hard stuff to “transport myself to another reality.”
He also convinced Ruth to move to Florida, in large part because of the fiercely negative connotations ice and cold had for him. Perhaps the most serious repercussion of Jim’s emotional trauma, however, was that it made him hypervigilant, especially with Michael. Only when Ruth protested that Jim was overly controlling did he finally back off. But that meant distancing himself from Michael, not learning to give him appropriate space to grow up. As a result, it was sometimes hard, Jim admits, to decide which version of himself was worse: overprotective, controlling Jim, or the distant, uncaring man who spent nights on the recliner with Johnny Walker Red.
Before Jim arrived in my Florida office, he had been to four mental health professionals over the years, but never went to more than three or four sessions with any of them. He was not about to try antidepressants again; “When I explained that to these shrinks, it looked like they were lost in the fear of ‘what do we do now?’”
Jim was pleased that I didn’t care if he took antidepressants. “They aren’t the answer to helping you heal from your losses.”
“You mean there’s a way to heal from this?”
“Actually, yes. I’d like to help you to get a place of peace, if you are willing to follow a plan with me. Healing requires action—there are things we need to do in order for you to recover from your losses.”
I explained PTSD to him using the following analogy: In some ways, your mind is kind of like the stomach. Whatever has not been digested may come back up on you. Of course, while the stomach can only keep food undigested for eight to ten hours, the mind can hold undigested material for decades without ever eliminating it. Healing requires the ability to release the painful material to regain any semblance of peace. I told him I wanted to help him release his trauma once and for all.
∞
Let’s leave Jim’s treatment for the time being. (I promise we will return to it later in the book.) But for now, let’s explore his many years of (unnecessary) suffering. Why was it that the mental health professionals he saw never helped him?
Societal bias has favored a medical model of treatment for most everything that ails us, including symptoms of PTSD and other forms of emotional trauma. Doctors have prescribed antidepressants for symptoms of depression and anxiety, tranquilizers and sedatives for insomnia, and mood stabilizers to address emotionally instability. If all else fails, antipsychotic medication has been prescribed as “a glue to keep it together.” Unfortunately, an abundance of research demonstrates that medications at best mask symptoms of PTSD and at worst create numerous and often debilitating side effects. The U.S. Department of Veterans Affairs2 states that “Trauma-focused psychotherapies are more efficacious than pharmacotherapy and are strongly recommended treatments for PTSD.” (Jeffreys, M. 2017) A booklet provided by the National Center for PTSD3 for veterans seeking treatment says, “Medications can treat PTSD symptoms alone or with therapy—but only therapy treats the underlying cause of your symptoms. If you treat your PTSD symptoms only with medication, you’ll need to keep taking it for it to keep working.” (National Center for PTSD, 2018,) The VA, which is the biggest provider of trauma treatment, and National Center for PTSD, which is the biggest researcher of PTSD, both agree that medication never helps the underlying cause of the symptoms—the unresolved trauma. In fact, by successfully masking symptoms, medications may actually interfere with effective treatment, as clients may settle for a treatment that distances them from their emotional pain. Antidepressants and tranquilizers are notorious for masking emotional pain (emotional anesthesia), although they can prevent people from disintegrating into a puddle of tears. Most people enjoy that feature of antidepressants, and they often conclude that masking the pain is as good as it’s going to get.
Ironically, one of the prominent symptoms of PTSD is avoidance, as noted above in Jim’s story. Consequently, let me state this as boldly as possible (I’ll even use bold print): Prescribing only psychotropic medication without healing psychotherapy may contribute to the client avoiding the problem, rather than addressing and healing it! In fact, while I’m out of a controversial limb, “medication only” treatment for unresolved emotional trauma can be tantamount to enabling the client to remain stuck in the symptoms of PTSD.
Medicating clients’ suffering without addressing the place where they are stuck in the pain of the past supports them in remaining mired there without having to address and resolve the underlying issue(s). Moreover, if clients are numb enough to function (albeit unhappily), they can avoid facing their pain head-on, which is a requirement of effective psychological treatment. After all, people don’t tend to present for psychological treatment unless they are in crisis mode—in layman’s terms, not unless they’re coming apart at the seams. Alas, as the great Dr. James Framo4, a former professor of mine, used to say, “People don’t change unless it’s too painful not to.”
If medication separates people from their pain, they are less likely to address their underlying issues. Allow me a crude but hopefully accurate analogy: If a client has a large, unpassable kidney stone trapped in the ureter, the pain motivates the client to find a doctor who can remove it. But if allowed generous amounts of opioids, that same client may postpone (i.e., avoid) the surgery indefinitely, as long as the pain is manageable. If the stone isn’t removed from the ureter, though, it will do long-term damage.