Managing Abandonment Depression in Complex PTSD

May 06, 2011 1:32 PM | Anonymous
By Pete Walker

One of the most difficult features of Complex PTSD is extreme susceptibility to painful emotional flashbacks. Flashbacks are painful layers of reactions C physiological, behavioral, cognitive, and emotional - to the reemerging danger and despair of childhood abandonment. This article maps out these layered, defensive reactions and offers a treatment strategy for managing the depression that underlies them. Here is a model of the layering of an emotional flashback. Experiences of depression and abandonment trigger fear and shame, which then activates panicky Inner Critic cognitions, dedicawhich in turn launches an adrenalized fight, flight, freeze or fawn trauma response [subsequently referred to as the 4Fs which correlate respectively with narcissistic, obsessivecompulsive, dissociative or codependent defensive reactions].

Here is a common example of a flashback. A complex PTSD sufferer wakes up feeling depressed. Because childhood experience has conditioned her to believe that she is unworthy and unacceptable in this state, she feels anxious and ashamed. This in turn activates her Inner Critic to scare her with perfectionistic rants: No wonder no one likes you. Get your lazy, worthless ass going or you ll wind up a wretched bag lady on the street! Retraumatized by her own inner voice, she then launches into her most habitual 4F behavior; she either lashes out domineeringly at the nearest person [Fight/ Narcissistic] C or she launches busily into anxious productivity [Flight/ Obsessive-Compulsive] C or she flips on the TV and foggily tunes out or dozes off [Freeze/ Dissociative] C or she selfabnegatingly redirects her attention to a friend's problem [Fawn/Codependent]. Unfortunately this dynamic also commonly operates in reverse, creating perpetual motion cycles of internal trauma as the dysfunctional behaviors of 4F acting out beget new self-hating criticism, which in turn amps up fear and shame and finally compounds the abandonment depression with prolonged experiences of self-abandonment. Here is a diagram of these dynamics: Triggered ABANDONMENT DEPRESSION ← → FEAR & SHAME ← → INNER CRITIC Activation ← → 4Fs.

This article describes a treatment approach that decreases retraumatizing reactivity to the internal affects of the original abandonment depression. It describes a Mindfulness practice for somatically metabolizing feelings of depression and fear. This in turn promotes the ability to feel through abandonment experiences without launching into inner critic drasticizing and 4F acting out.

The etiology of a self-abandoning response to depression. Chronic emotional abandonment devastates a child. It naturally makes her feel and appear deadened and depressed. Functional parents respond to a child s depression with concern and comfort. Abandoning parents respond to it with anger, disgust and/or further abandonment, which in turn create the fear, shame and despair that become characteristic of the abandonment depression. A child who is never comforted when she is depressed has no model for developing a self-comforting response to her own depression. With no connection to a nurturing caretaker, depression steadily increases and sometimes devolves into the Failure to Thrive Syndrome. In my experience failure to thrive is not an all-or-none phenomenon, but rather a continuum that stretches from excessive depression to death. Many PTSD survivors thrived very poorly, and had painful bouts of lingering near the end of the continuum that feels death-like. Several of my clients commonly quipped that they feel like death warmed over when they are in a flashback.

When a child is consistently abandoned, her developing superego eventually assumes totalitarian control of her psyche and carcinogenically morphs into a toxic Inner Critic. She is then driven to desperately seek connection and acceptance through the numerous processes of perfectionism described in my article Shrinking the Inner Critic in Complex PTSD [downloadable from www.eastbaytherapist.org or www.petewalker. com]. Imitating her parent s contempt for her emotional pain, she also becomes emotionally perfectionistic and judges her dysphoric feelings as the cause of her abandonment. Over time her affects are repressed, but not without contaminating her thinking processes. Unfelt fear, shame and depression are transmuted by the inner critic into thoughts and images so endangering, humiliating and despairing that they instantly trigger escapist 4F acting out. Eventually even the mildest hint of fear or depression, no matter how functional or appropriate, instantly morphs into the danger-ridden overwhelm of the original abandonment. The capacity to selfnurturingly weather any experience of depression, no matter how mild, remains unrealized. The original experience of parental abandonment devolves into self-abandonment. The ability to stay supportively present to vital aspects of inner experience gradually disappears.

Deconstructing self-abandonment. We can gradually deconstruct the self-abandoning habit of reacting to depression with fear and shame, inner critic freak out , and 4F acting out. The processes described in this article and my paper: Managing Emotional Flashbacks in Complex PTSD [also available on the aforementioned websites] awaken the psyche s innate, developmentally arrested capacity to respond amelioratively to depression and the fear and shame that attaches to it. This is typically a long difficult journey, however, because our culture routinely humiliates any expression of fear, and depression is often seen as an unpatriotic violation of the pursuit of happiness . Taboos about depression even emanate from the psychological establishment, where some schools strip it of its status as a legitimate emotion C dismissing it simplistically as mere negative thinking, or as a dysfunctional state that results from the repression of somewhat less taboo emotions like sadness and anger.

Healing progresses when we learn to distinguish depressed thinking C which can be eliminated C from depressed feeling C which must sometimes be felt. Occasional feelings of enervation and anhedonia are normal and existential - part of the admission price to life. Moreover, depression is sometimes an invaluable harbinger of the need to slow down, to drop down internally for rest and restoration. At its healthiest, depression accesses a unique spring of intuition, such as that which informs us of the obsolescence of a once valued job or relationship.

Overreaction to depression essentially reinforces learned toxic shame. It reinforces the individual s belief that he is unworthy, defective and unlovable when depressed. Sadly this typically drives him deeper into abandonment- exacerbating isolation. Deep level recovery from childhood trauma requires a normalization of depression, a renunciation of the habit of reflexively reacting to it. Central to this is the development of self-compassionate mindfulness C the practice of staying in one s body, of staying fully present to all internal experience. Mindfulness cultivates our ability to stay acceptingly open to our emotional, visceral and somatic experience without 4F acting out.

A relational approach to healing abandonment. Most Complex PTSD clients have never had a safe enough relationship. Healing their attachment disorders requires a reparative relational experience with a therapist, partner or trusted friend who has the capacity to stay unreactively present to their own depression and the various affects that attach to it. When a therapist has this level of emotional intelligence, she can guide the client to gradually release the learned habit of automatic affectrejection and defensive reactivity. Safe and empathic eye and voice connection with an individual with good enough emotional intelligence provides a working model and a limbic resonance to help her stay unreactively present to all her affects. Daniel Siegel calls this the coregulation of affect. Moreover, as Susan Vaughan s avers in The Talking Cure, such work appears to promote the development of the inner neural circuitry necessary to healthily manage and integrate depression and its attenuated affects.

Somatic mindfulness. Therapists can guide clients to focus on and stay present to their somatic experience of abandonment fear and depression. Because depression commonly morphs instantly into fear, early work involves staying present to the kinesthetic sensations of hyperarousal and the psyche s penchant to dissociate or distract from them. Dissociation is either the classical right brain distraction of spacing out into reverie, fogginess or sleep C and/or it is the left brain, cognitive distraction of worrying and obsessing. Particularly notable here is the inner critic s dissociative transformation of fear and depression into drasticizing scenarios about the client s imperfections. Over and over, we need to guide the client to rescue himself from dissociation [left and/or right], and to gently bring his awareness back into fully feeling and experiencing the sensations of his fear and noticing his reactions to them. Mild sensations of fear are muscular tightness or tension anywhere in the body, especially the alimentary canal. More intense sensations of fear are nausea, jumpiness, wired-ness, shortness of breath, hyperventilation, electric shock and diarrhea. Although sensations of fear typically feel unbearable at first, persistent focusing with nonreactive attention ameliorates or resolves them C as if awareness itself is digesting and integrating them.

It is important to note here that this type of kinesthetic focusing often triggers memories and unworked through feelings of grief about the client s abuse and neglect in his original abandonment. This provides many invaluable opportunities to ameliorate PTSD by more fully grieving the losses of childhood. Therapists can also use the results of such explorations to foster the creation of an egosyntonic and self-compassionate narrative that deconstructs the shame and self-blame the PTSD client typically assigns to her suffering. I describe a safe, efficacious process for this type of grief work in my book, The Tao Of Fully Feeling: Harvesting Forgiveness Out of Blame.

With considerable practice, the client eventually begins to exhume from his fear, an awareness of the more elemental, underlying sensations of depression C hypoaroused sensations exceedingly subtle and barely perceptible at first. These sensations are initially as difficult to stay present to as those of fear. With guided ongoing practice however, focused attending also digests them as they are integrated into consciousness. As practice becomes more proficient, these feelings and sensations of depression can morph into a sense of peace, relaxation and ease - and sometimes open to underlying, innate core emotional experiences of clarity, confidence and belonging.

Introspective Somatic Work.
Therapeutic gains in reducing self-abandonment are augmented by individual work. I was daunted in my own mindfulness work at the frequency with which my awareness yo-yo vacillated between my body and my mind C between tense sensations of fear and the myriad fear-tainted mentations of my inner critic. These catastrophizing thoughts and visualizations were my critic s misinterpretations of my fear, based on unconscious beliefs that I was still stranded in the dangerous abandonment of my childhood. My critic excoriated me incessantly to launch into flight-mode and strive for safety through productivity and perfection. In the first year of this practice I frequently had to white-knuckle the handles on my chair to stay somatically present to my feelings - to stop myself from self-medicating into excessive adrenalization. I had survived my childhood with ADHD-like busyness C with marathons of activity that kept me one step ahead of my fear- and shame-saturated depression. Gradually as I used my focused awareness to ameliorate my fear, I experientially discovered the rock bottom underlying core sensations of my abandonment depression itself. Over and over I focused on sensations of heaviness, swollenness, exhaustion, emptiness, hunger, longing, soreness, deadness. Sometimes these sensations were intense, but more often they were very subtle. With time I noticed how instantly my depression scared me and lead me to echo my parents contempt: You re bad, worthless, useless, defective, ugly, despicable . Blessedly, with ongoing practice, I gradually learned to disidentify from the toxic vocabulary of the critic. I found myself more accurately naming these revisited childhood feelings: Small, helpless, lonely, unsupported, unloved. Over time, this in turn rewarded me with a profound sense of compassion for the abandoned child I was.

Camouflaged Depression.
Feelings of abandonment commonly masquerade as the physiological sensations of hunger. Hunger pain soon after a big meal is rarely truly about food, but rather about emotional hunger and the longing for safe, nurturing connection - for the satiation of abandonment. Even after a decade of practice, I still find it difficult to differentiate this type of attachment hunger from physical hunger. One, often reliable, clue is that the sensation of longing for the nourishment of attachment is usually in my small intestine, while physical hunger s locus is a little higher up in my stomach. [I believe sex and love addicts desperate pursuit of high intensity relating is also often an attempt to self-medicate deeper abandonment pain and unmet attachment needs].

Pseudo-Cyclothymia. On a parallel with false hunger, feeling tired is sometimes an emotional experience of the abandonment depression, and entirely unrelated to sleep deprivation C although over time the two can become confusingly intertwined. The emotional tiredness of not resting enough in the comfort of safe attachment and belonging, often masquerades as physiological tiredness. When our abandonment depression is unremediated, any kind of tiredness C emotional or physical - can trigger us into fear, which the inner critic then translates into endangering imperfection , which in turn triggers us into one of the 4F responses. Ironically, over-reacting to emotional tiredness eventually creates real physical exhaustion via a process I call the The Cyclothymic Two-Step. This is the dance of flight types who habitually overreact to their tiredness with workaholic or busyholic activity. Self-medicating with their own adrenalin, they run to counteract the emotional tiredness of unprocessed abandonment depression. Eventually however, many exhaust themselves physically, and become temporarily too depleted or sick to continue running. At such times, they collapse into an accumulated depression so painful, that they re-launch desperately into flight speed at the first sign of replenished adrenalin. Such clients sometimes pathologize themselves as bipolar because of their abrupt vacillations between adrenalin highs and abandonment- exacerbated lows. Also noteworthy here is the futile journey that many survivors undergo treating emotional tiredness with physiologically- based methods. The limited efficacy of such an approach however typically augments their shame: What s wrong with me. I've changed everything in my diet and in my sleep and exercise regimen. I ve seen every type of practitioner imaginable and I still wake up feeling dead tired. I believe the healthiest way out of this cul-de-sac of self-destructive and unwarranted efforting lies in cultivating selfcompassionate acceptance of the inexorability of sometimes feeling tired, bad, lonely, or depressed. In this regard, the notable AA 12 Step acronym, HALT - Hungry, Angry, Lonely, Tired C can remind us to assess whether these feelings are actually signals that our abandonment depression has been triggered and needs the quiet, internal, self-compassionate attention described above.

Conclusion.
We can sometimes gain motivation for this difficult work by seeing our depressed feelings as messages from the developmentally arrested child who is flashing back to his abandonment in hopes that his adult self will respond to him in a more comforting and protective way.

Through such practice, clients can gradually achieve the healing that the Buddhists call separating necessary suffering [normal depression] from unnecessary suffering [unconscious stuckness in hopelessness, toxic shame and fear, retraumatizing inner critic acting in, and 4F acting out].

Pete Walker is director of the Lafayette Counseling Center, a sliding-scale agency that specializes in working with complex PTSD, codependency and recovery from childhood abuse and/or neglect. His website www.pete-walker.com, contains many downloadable articles on these subjects. He is also the author of The Tao of Fully Feeling: Harvesting Forgiveness Out of Blame. Information on his CEU class in Relationship Supervision is contained in the classifieds of this issue. He can be reached at (925) 283-4575.
 

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