I've recently noted a convergence of ideas that leads me to put a lot of credence in what follows and also a degree of confidence that I'll be better able to treat patients with a history of trauma. One idea comes from the emerging psychedelic movement; the mind has a natural tendency to self-heal. Coincidentally I have been working with patients with trauma and identity concerns. This work has caused me to stumble into the writings of Abraham Maslow, an author whose fame had led me to know of his 'hierarchy of needs,' but little else.
A fundamental idea of Maslow, similar to the idea promoted by the psychedelic movement, is that the mind has a natural impulse to grow. He argues that this happens when people encounter tensions, particularly those in which circumstances butt up against ones sense of identity, The urge to resolve these tensions often leads to growth and maturation. Maslow's book, 'Toward a Psychology of Being,' amply describes his theories. The most important concept for our purposes is that pain or psychological tension is a necessary motivator for growth. A rub is that trauma often blocks a patient's ability to tolerate normal tensions. In what follows I'll briefly introduce the notion of the 'kind world,' in distinction to the traumatic world, and will introduce the paradox that it is by experiencing conflict in the kind world that traumatized patients can eventually find their way back to it.
Let me introduce the notion of the 'kind world,' and contrast this with the traumatic world. In the traumatic world there is no room for psychological space. Harm is being done, it is intolerable and must be stopped at any cost, there can be no middle ground. Tension in the traumatic world is by definition, traumatic and unacceptable.
The kind world in contrast, is a nurturant world. True, it is imperfect. It is a world where there is sometimes indifference and occasional clashes of will, it is a world in which we are not immune to non traumatically hurting one another. But being essentially a nurturant world, it is the world in which, like a good garden, the ingredients are present to promote growth.
A history of trauma often interferes with patient's ability to experience and profit from the kind world. In effect, these patients are excluded from the kind world. Ordinary tensions that are inevitable in the kind world and, according to Maslow promote growth are treated as traumatic. Let me give an example: a young woman I treated would not permit me an ordinary level of human inexactness. If I misunderstood her she would react with immediate psychological flight, usually with a display of temper followed by a period of shutting down. It was as if ordinary tensions were being confused with traumatic ones. Her reactions were entirely understandable in light of her history, but they deprived her of the necessary psychological space to digest non traumatic tensions. The resolution of interpersonal tensions has the potential to provide affirmation of the self and often increased trust in others. Psychological closure or brittleness can prevent this from happening. In essence, psychological space in the context of ordinary tensions allows people to work through these tensions, often to their benefit and growth.
Psychological space is also important for the evolution of identity. Maslow points out that it is when our sense of self clashes in a painful way with the 'kind world,' that creative steps are taken which promote maturation of personality. In essence, people who have been traumatized can become frozen in their development.
The psychedelic movement teaches us that in the middle of an altered state people do best to stay with, rather than flee from tension. It is by staying with tension that enlightenment often follows. Some one third of patients exposed to LSD have a so called bad trip, while in the aftermath, 80 percent of these same people will describe the experience as having been very worthwhile.
So how can we turn these thoughts on trauma and psychological space into clinical advantage? I am a believer in being open and explicit to patients about some of the ideas and techniques I use. Why not explain the concepts above to a patient when the time is right? It is also important to slowly titrate tensions when confrontation. arises in order to minimize it being experienced as traumatic. It is a mistake to overload patients, but it perhaps an even greater mistake to avoid it. The latter is a silent and inconspicuous offense, for in ordinary social interaction we are programmed to avoid confrontation. And patients, who are often afraid will be complicit in our avoiding it. Yet by accepting that tension in ordinary living is inevitable, and using our skills to titrate it, we help patients discover the safety of the kind world and hopefully invite them back into it.
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