But the toe was communicating pain, which we understand is the body’s way of relating that something is wrong. The message of consistent pain for several months should have been a good enough signal to me that there was something wrong. Only when I finally addressed the pain and removed the splinter did the toe return to normal.
And from my extensive work with trauma survivors, that is exactly how it works. When the traumatic episode(s) is satisfactorily digested (removed, assimilated, and released), the need for the PTSD symptoms fades away.
Survival Mechanisms Send Conflicting Messages
But sometimes the PTSD symptoms send very conflicting messages: you need to remove the splinter (trauma), but I will try to bury it so you won’t or don’t have to deal with it. The repeatedly molested child, for instance, is often incapable of addressing her traumatic experiences while she’s still young. Consequently, the mind’s protective system may allow her to block the ugly traumas out for many years to promote her survival until she is finally equipped to deal with her abuse, often many years later.
Contradictory messages from your protective mindset serve a purpose. A middle-aged Terri tells me the story of surviving a “home invasion,” where the intruder grabbed wallets, cash, and jewelry before stumbling down the stairs and escaping into the night. She presents one month later with the predictable PTSD symptoms; she continues to re-experience the event, especially running after him and yelling “who are you?,” and then watching him fall and run away. The nightmares and flashbacks do very much the same thing—remind her that her trauma (like the splinter) has not yet been dealt with.
There are symptoms of avoidance: buying an alarm system and not wanting to sleep alone (she invites her eleven-year-old to snuggle with her as they’re both “spooked” by the violation). She also checks and re-checks locks as if they weren’t successfully locked the last three times she locked them. And of course, she is experiencing the exaggerated startle response, hypervigilance, and excessive anxiety. This is all easy to understand, since Terri no longer perceives her world as safe since the home invasion.
From one perspective, Terri’s symptoms are functional. She needs to successfully process the trauma to release it, so flashbacks and intrusive recollections are useful. The avoidance symptoms of feeling a need to buy a house alarm and check locks (not to an excessive OCD level) are logical responses to the home invasion. Even the startle response and hypervigilance are ingrained reflexes designed to keep Terri alive and well.
From another perspective, though, Terri’s symptoms are irrational. Let’s say you’re a driver returning to the road after an automobile accident. Your goal should not be hypervigilance, only appropriate caution. You don’t need to check your side mirrors twenty-seven times, two should suffice. Alert is good, but employing the “grip of terror” upon the steering wheel is not.
For Terri, being hyper-aroused (extreme anxiety) and watching for potential intruders and assorted bad guys seems appropriate, but more than likely, it will do more harm (in terms of insomnia, anxiety, and depression, as well as irritability, family conflict, and poor work performance) than good. Again, appropriate vigilance, checking the doors and having a dog and/or a non-canine alarm system makes sense. Hypervigilance, not so much.
Terri grasps how her symptoms have crossed the line. But letting go of these symptoms—putting them away—is a challenge because her mind’s protective system may fight to retain them due to their perceived usefulness. In other words, letting go of the checking, the worrying, the relentless scanning, and her overreaction to the shadow created by her standup Hoover vacuum may make Terri feel vulnerable. She may resist giving up her newfound internal security system.
So, what can be done to help Terri to let go of her disruptive PTSD symptoms while retaining a healthy—not careless, not excessively guarded—system of self-protection? Let’s talk treatment.
Trauma (PTSD) is Treatable
Needless to say, if trauma were not treatable (and yes, very often curable), there would be no reason to write this book. But there is successful treatment, and it’s about time someone taught it to you. Now that you understand how trauma symptoms are at least in part functional and are built to sustain or preserve life, you possess a perspective that will facilitate treatment—a perspective on how to use the Fritz.
Fritz Perls, as you remember from Chapter 1, was the German-born psychotherapist who founded the Gestalt school of therapy. Perls and Gestalt therapy were tremendously popular in the ’50s and ’60s, but Perls’ work at the Esalen Institute in Big Sur alienated traditional therapists who didn’t like how some people were embracing it as a lifestyle (i.e. mindfulness, meditation, etc.). Over time, some of Gestalt’s general concepts were absorbed into the Cognitive-Behavioral school, but many of Perls’ brilliant innovations were lost after his death in 1970.
Perls emphasized closure.33 He believed, as do I, that the issues with which humans struggle have power over us—think the stress response—until we find a way to close the wound. Again, that means putting these issues in a place where you can accept the trauma, both that it happened and that it cannot be changed, fixed, or undone. All you can do is accept it and then, perhaps, find meaning in your suffering and possibly create a plan to make your life better because of your resilience.
Recognize, though, that you have to go beyond a cognitive admission that the trauma occurred—that you were betrayed, abused, and so on—and that nothing can be done about it. For the splinter to be removed, you will need to face the pain from the trauma head-on, every aspect of it, and feel, express, and release the memories and the accompanying feelings before you can achieve acceptance, or make peace, shut off the stress response, remove the splinter, however you want to describe it. You must complete the horror of the trauma and the feelings you have been running from by expressing and releasing them. Dave’s story illustrates this process nicely.
Years ago, the fire chief called me one day to discuss an emergency—twenty-six-year-old police trainee Dave had accidently been shot in the face with blanks during a training session. Sometime later, Dave’s wife found him in the bathroom behind closed doors with a loaded gun in his mouth. He was now considering suicide because he couldn’t deal with the recurrent nightmares of the shooting, night in and night out.
But why was the shooting returning to Dave on a nightly basis? Because he had not allowed himself to process and complete the trauma. The repetition of the event was the mind’s way of alerting him that he was frightened and overwhelmed by the shooting and needed to express and release those feelings, once and for all.
Dave needed only one session of guided imagery (much more about this later in the book) to complete his trauma. Interestingly, he dreamed of his trauma one more time the night of our session and then never again. He had put the horror of the incident away for good.
Interestingly, in Dave’s case, the severity of his symptoms, especially his suicidal thoughts, worked in his favor, because he was forced to get treatment and deal with the horror shortly after the trauma. Typically, police officers and other first responders are discouraged from thinking or talking about their traumatic experiences on the job, and they experience a disproportionately high rate of PTSD as a result.34
Putting on the Fritz
So here is the Fritz, a new paradigm for successful treatment of trauma/PTSD. It’s a simple five-step process for treating PTSD. Fritz Perls, the German psychologist who inspired this process, would describe trauma and the associated symptoms as “unfinished business.” He would remind the suffering client