*All descriptions of clinical material are always reviewed with the person involved and shared with their permission.
I was invited to be the guest speaker on this half-hour radio talk show to discuss how trauma can impact children and parents. The show is part of You Gotta Believe!, a program that finds homes for transition age youth (older teens and pre-teens).
You can listen to the show by clicking here.
Or visit the radio show's webpage.
The BI-SLR HEARTS Program, which I developed and have directed since 2009, has been newly-appointed a Center of Excellence within the newly formed Mount Sinai Health System. The new name for the program is the Center for Child Trauma and Resilience at Icahn School of Medicine at Mount Sinai. This appointment is a recognition of all of the great work the program does to advance the science and treatment of child traumatic stress and should help us build new collaborations and opportunities within the health system. I'll post a link to the new webpage within the health system when it's up and running. Thanks to my staff without whom this recognition would not be possible.
Lsat week, the NYC Citywide Oversight Committee, which helps implement the NYS Children's Plan and NYC's system of care, invited me to provide an introductory training on child traumatic stress to launch this years focus on spreading trauma-informed care. The presentation was received with rave reviews and the COC is now asking me to figure out how to spread this training throughout all of the boroughs and beyond. We are starting with a presentation the the Queens Borough Based Council in Jamaica, Queens, on 10/27/14 from 9:30-11:30. All are welcome to attend.
The address is 90-27 Sutpin Blvd, 2nd Floor, Queens, NY 11435.
The Sewol Ferry boat accident is one of South Korea’s worst peacetime disasters. With the advent of international Korean television and 24-hour news coverage, Koreans living all over the world are as devastated as their counterparts in Korea. TV stations canceled comedies and dedicated all airtime to somber coverage of the tragedy. Koreans grieved collectively and honored the dead and their families by doing nothing except think about the tragedy. People wore yellow ribbons in commemoration, but no one knew when to take them off without appearing heartless.
As a Korean American psychologist studying and treating traumatic stress, I believe that understanding how we all react to traumatic stress can help us cope with the tragedy effectively and reasonably.
First, every one of us has a stress response system that many trauma experts simply call the “body’s alarm.” The alarm is designed to keep us safe. It sits in a primitive part of the brain called the limbic system and screens all incoming sensory information for threat. Threat can be directed towards ourselves or someone we love. Threat can also be real or imagined. That’s why parents can be even more traumatized by this tragedy. They cannot help but imagine their own children on that boat, sinking, screaming, and dying in the goriest detail their alarms can imagine.
Once the alarm is triggered, it does two things. First, it immediately prepares the body to either fight or flee. We feel a rush of energy as adrenaline enters the blood stream. Our hands get sweaty, our heart races, breathing quickens, and blood and energy get diverted away from our gut, leaving us feeling a little queasy. Second, the alarm alerts the neocortex, the higher part of the brain, to pay attention and make sense of what’s going on and what needs to be done. Our attention orients to the biggest threat. We all turn to watch. We have to.
In the wild, when an animal is threatened by a predator, its alarm goes off and it fights or flees. When the threat has ended, the animal shudders off the remaining adrenaline, catalogs the experience and the threat, and returns to grazing, wandering, living life. Unfortunately, tragedies often do not provide us a natural outlet for alarm energy. The alarm energy stews in our bodies, driving our neocortex to keep looking for the enemy, to keep fighting or running away.
In this state, the alarm can hijack the brain. Every time it sees another video of the children drowning, it creates more alarm energy, spurring us to rescue them. The mind is driven mad with rage and looks to find who is to blame. We cry “murder!” and rabidly blame everyone we can, from the ship’s captain to the Korean president. The hijacked brain no longer thinks complexly, but only in the simplest terms—safe or dangerous, good or bad. The enemy becomes dehumanized, demonized.
But, the hijacked brain suffers more when the enemy is within. Korea is torn between shame over its own negligent corruption and a desire to criminalize and punish everyone involved.
I think this is why tragedies caused by acts of terror are easy for a nation. Look at the United State’s response to 9/11 or the Boston Marathon Bombing. The enemy was known and already identified as different. The nation united together and resumed living as soon as it could, rallying around the notion that it would not let terror win. Our TV shows started with a moment of silence, then we laughed and lived with renewed vigor and determination.
Koreans must not let alarm energy divide us. We must remember that we are all imperfect, capable of frail, selfish acts, and more importantly, realize that these acts also most often stem from minds hijacked by alarm.
Some parents ask me “But, how can I guide my children to obey authority figures any more?!” To these parents, I first invite them to recognize that maddening alarm energy is what drives the despair underlying this question. And, I remind them of what Obama said after the Newtown shooting:
This evening, Michelle and I will do what I know every parent in America will do, which is hug our children a little tighter and we’ll tell them that we love them, and we’ll remind each other how deeply we love one another.
Then, I remind them that the world is as it always has been—filled with beauty and horror, the magical and the mundane. This was an extremely rare accident in a world that is generally safe though still requires us to be reasonably cautious and careful. Children should still assume that adults care for them and protect them, while still exercising caution and good judgment. Then, I ask them to remember what they really care about for their children, which is to teach them to love and live with dignity and virtue.
We cannot despair. We need to recognize how much our alarms have hijacked our rational thinking and expend alarm energy by first allowing ourselves to feel overwhelming grief, sadness, helplessness, fear and rage. We must take time to experience our feelings fully without immediately converting them into action. We must understand that feelings are like the weather that comes with every season. Though some may be unpleasant, it always passes and even rain and snow nourishes this life on this earth.
Then, we can reclaim more of our minds by doing what our higher minds do best—remember the people we love and the values that define us. It produces feelings of calm, confidence, compassion, forgiveness and responsibility. These feelings need to co-exist with our grief and rage, so we can most effectively honor our alarm’s need to protect our children but also insure that we create a world that teaches them how to love and live with virtue. This is truly the only way that we can weed out the corruption, greed and other human frailties our alarms are begging us to destroy.
I'm going to be the key speaker/facilitator for a free "talk concert" to help the Korean community heal from the Sewol ferry boat tragedy. The event will take place at Flushing Hospital on June 21st, 2014, from 1-5. Though I don't speak Korean, the event will be translated for a Korean audience. The structure of the event will be mix of didactic education about trauma and coping, music, and small group discussion.
I'll be joined by Christina Love Lee, a music therapist, who placed 4th on a Korean music competition show called Superstar K.
Here's a video of her singing in English at the Village Undergrounds. Isn't she amazing?
A young infant cries, because that is almost all they know to do. An attentive parent says, “Oh, so tired!” and picks her up. The infant quickly settles.
Another infant waits for his mother’s gaze. When caught, he smiles; she smiles back.
A toddler is playing in a new and strange waiting room, sees a curious object across the room and looks pensively at her father. He says, “It’s okay.” She gathers herself and proceeds to the object, assured that her father still watches.
Leaving my office, a preverbal two-year old cries “broke!” because the head of his lollipop fell off. His mother, rushing to leave, says, “Forget the lollipop. Let’s go! There’s another one in the car.” The boy stays, absorbed in the tragedy. She threatens to leave him and walks towards the exit. He cries harder, “Broke, broke!” I say, “Oh no! The lollipop broke?!” He says “yeah” despondently, settles, moves on.
A verbal toddler watches traffic pass by, while I converse with my friend. He sees a truck, points and says, “truck.” My friend ignores him to continue our conversation. Growing agitated, he insists louder and louder, “truck, Truck, TRUCK!” Without missing a beat, my friend turns to him, says, “Truck!” and returns to our conversation. He settles; resumes his watch.
A preschool child yells, “I hate class! I don’t want to go! You can’t make me!” Her father asks, “Are you nervous about going to class?” The child looks down, settles comforted, waits.
A colleague shares her pain in our secondary trauma support group. The rest of us sit in silence, allowing our full presence to hold her pain among us, restraining our urge to make it better, fix it or hurry it away.
A new patient leaves me a voice message angry that I suggested an exposure exercise for homework. She has just read a news story in which another trauma expert derided exposure therapies. When she comes for therapy, I explain how the exercise is different in a way that satisfies her. I see the fractal of her infant self crying, desperate, and tell her, "Right now, I hear you also saying, 'I’m scared to start therapy and face my traumas, and I am not sure I trust you yet.'" She tears, breathes and settles, telling me how afraid she felt the night she called.
The need to be known is universal and devastating when denied. It’s rooted in an infant’s cry and flourishes into thou and I.
Trump Hotel Central Park generously donated a two-night stay in one of their executive, one-bedroom, Park-view suites on Friday April 11 departing Sunday April 13, 2014.
The Executive Park View suite is a 950 sq. ft. one bedroom suite featuring floor to ceiling windows with breathtaking views of Central Park. The bedroom has a luxurious king-size bed and master bath. In addition, this suite offers a European-style kitchen and a separate living room complete with a full-size sofa bed, dining room table & chairs and half-bath.
The Retail Value of the stay is $5000!
This auction is paired as part of a squash tournament fundraiser I am co-hosting that weekend at the Sports Club/LA on the Upper East Side.
Proceeds for this auction will benefit the Mount Sinai Beth Israel HEARTS Program, which I direct. This program serves children, youth and families who have experienced trauma and violence, particularly those involved in child welfare, juvenile justice, and the military. We provide direct clinical interventions and do a large amount of training for agencies in NYC and across the US.
To place a bid, leave a comment below and please include a valid email address when you register so that I can contact the winning bidder after the auction is over -- if the winning bid is submitted without a valid email address, I will award the item to the next reachable bidder.
Bidding starts at the minimum price of $300. Please bid in increments of $10 or more.
The auction closes at 5 pm on Tuesday April 8!
I'm just returning from the National Child Traumatic Stress Network's All Network Conference. I heard two stories about pivotal moments that turned two lives around, one from suicide and one from a life of violence. Both moments revolved around thinking of moms, one's own and other's moms, and sparing their lives of further grief. I took away from these stories the tremendous importance of love, feeling love and feeling loved.
I never hear these stories mention therapy as the key ingredient to transformation, though I've certainly seen the power of therapy to help change lives. I'm humbled to know that all of my profession's fancy expositions about the key ingredients to therapeutic change are nothing if not performed with love. A love that conveys that
You are Valued
You are Seen
You are Felt
You are Known.
Thank you to all the moms out there, biological and spiritual.
RIP Patricia Van Horn
RIP Jan Markiewicz
Sometimes change is hard. As a person changes in therapy, they become a better self. Some people feel really bad about who they were before therapy. For instance, many people become more caring for others and regret having lived so selfishly in the past. I think these people had to be selfish in the past because caring was too dangerous. When people have experienced significant interpersonal hurt, connecting with others just leads to more hurt. One’s self-protective instinct says, “Don’t you dare open up again!” Yet, as one grows in love, self-acceptance and healing, it’s hard to keep disconnected from others. Therapy heals the heart and when the heart opens it necessarily begins to connect with others. That’s its function: to remember and extend our interconnectedness. So, if this interconnected caring feels too unfamiliar, strange and frightening, remember what you really value and care about, which for most people includes love and being loved.
If anxiety and fear drives you, your only chance of thinking clearly is to remember what you value most. ...a soldier’s courage carried by love for fellow soldier, a patient’s perseverance for the sake of self waiting to be born.
I was explaining trauma reactions as an over-active alarm system. One of the women looked deep in thought. I asked what she was thinking about. She was thinking about her 5-year-old, adopted niece and how she might use what she was learning to react differently to her niece’s meltdowns. She explained that when her niece has a meltdown, she immediately just wants to get away from her. She now sees this as her own alarm reaction leading to a flight response. She said she felt guilty for responding this way because she knows that her niece probably feels abandoned by her when she walks away because of her history of abandonment and loss. She wanted to not run away but didn’t know what else she could do. I commended her for recognizing that her alarm was being triggered and also helped her see that her feelings of guilt were also an alarm reactive feeling. I then explained that the alarm is meant to help her notice that something was happening that activated an important value for her. So, when her alarm is triggered, the best way to calm it down is to think about what really matters most to her in that moment. She said, being there for her niece.
Me: Okay, then how does thinking of being there for your niece make you feel?
Her: I feel a little calmer.
Me: And how do you feel about your niece when you are thinking of being there for her?
Her: I feel love for her.
Me: Great, now from that place of calm and love, what would you want to say to her?
Her: I don’t know.
Me: How about if you just walked into that room, sat next to her with that calm and loving energy, and just said, “I’m sorry you are having such a hard time right now. Seeing you like this makes my alarm go off, but I’m not going to leave. I don’t know what to say, but I’m just going to sit right here and stay with you until you calm down.” How would that feel?
Her (tearful): Better.
(some of this technique must be credited to TARGET).
At the end of this training, another participant's adopted son posted this on his Facebook page.
I’ve been thinking a lot about managing difficult conversations recently because of some intense family work I’ve been doing and thought I’d write out my ideas to help me understand them. Please feel free to comment and ask for clarification to help me further my thinking.
The gist of what I think heavily borrows from three books but with a trauma twist: Difficult Conversations, Seven Principles for Making Marriage Work; and Hold Me Tight.
So the bulk of what I seem to be doing in therapy nowadays when it comes to conversations is to help people attune to the multiple streams of discourse that are occurring simultaneously in any and all conversations. The most superficial stream is the actual topic and the words spoken. This current is the visible surface of every conversation. Under that is the current of feelings that are still visible from above but still sometimes requires the intentional light of attention to discover. Under that lies a deeper current about beliefs, particularly about the world and one’s values in the world. Here lie beliefs about how the world should work, how others should behave and how others should treat each other. The deepest and most difficult to find current of conversation is about beliefs about the self. What is this conversation implying about who I am as a person and my value as a person? Is this conversation making me look stupid, wrong, mean or smart, right, or otherwise virtuous?
Problems arise when the deeper currents are becoming agitated but the actual topic of conversation doesn’t move to focus on the underlying currents. Conversations about politics or religion are clear examples of when beliefs about the world become primary, but they are generally avoided because they agitate the currents of self-value, whether a person is fundamentally good and moral. Between parents and children, some conversations seem to be about mundane problems or challenges (like getting homework done or setting a curfew), but they suddenly and unexpectedly blow up because the conversation triggers feelings of “I’m a horrible parent” or “They’re treating me like a child and I am not a baby!” The tricky thing to do is to know when certain currents are taking primacy in a conversation and then being able to have conversations from that current.
When trauma is somehow in the picture (either trauma in the child, parent, or both), the waters become even choppier. Trauma has a tendency of hijacking any conversation, especially when there is strife, stress, or intensity. Trauma tends to escalate feelings very quickly too because one’s self-protective alarm response is easily triggered and rapidly mobilizes a fight or flight response. Trauma also gets deeply embedded in the currents of belief: the world is not safe, you are dangerous or scary, I can’t trust anyone, I don’t deserve love, or I deserve to be hurt.
In these situations, it’s even more important for people to watch for how trauma is distorting or impacting the current of conversation. And, when the conversation starts to feel heated, confusing, or frustrating, then I strongly believe that people need to take a pause to figure out what is happening at all currents of the conversation. Sometimes, this can be very hard to figure out, and people may not feel safe enough to share the deeper currents. That’s why a sensitive therapist can help people articulate the currents and do so in a safe way.
It’s still very hard, though; trust me.
Sir Patrick Stewart talks about how he grew up witnessing his father act violently towards his mother. Then, as an adult he learned that his father's violence stemmed from the PTSD his father experienced as a veteran of WWI. It seems to me that the traumas that nations experience seep into the individual lives of its citizens, its families, for generations. I think it is so important to realize that trauma is our adversary, not other human beings. This realization is one of the most difficult, but important ones to make for anyone who has been hurt by another ...and perhaps even more important for anyone who hurts others.
The best part of the clip for me occurs when everyone is focused on applauding Sir Stewart, but he himself stays wonderfully attentive and connected to the woman who asked the question. As a clinician who works with so many people touched by trauma, I can tell you that that caring, mindful awareness of others in the present moment is the hallmark of having healed and turned trauma into growth. For anyone who hasn't attained that growth, set course for that solar system and ...Engage!
This talk will certainly keep my batteries going in our work for justice-involved youth.
My Favorite Quote: we are always more than the worst thing we've ever done.
What's your favorite?
Here is a great video illustrating excerpts from DFW's commencement speech at Kenyon College in 2005. I post it here because I fully agree with it.
To entice those who won't watch it without some sense of what to expect, I'll tritely summarize (but I really think you should just watch it and read the full speech). The speech addresses the same issues Wallace was writing about in his unfinished novel, The Pale King. It starts with the notion that we all live life in the default mode of our own egocentric perspective. This, however, leads to a life of banality and meaninglessness, which we try to fill through worship of something--anything--whether spiritual, material or superficial. The only freedom from this banality comes from arresting the default egocentricity through radical awareness of the moment, which leads one to become aware of the experience of others. The best quote from the speech is:
The really important kind of freedom involves attention and awareness and discipline, and being able truly to care about other people and to sacrifice for them over and over in myriad petty, unsexy ways every day.
Such a loss that he left us so early. I wish I understood why the shackling weight of his own depression became no longer bearable.
The full commencement speech has also been made into a brief book called This Is Water: Some Thoughts, Delivered on a Significant Occasion, about Living a Compassionate Life. The entire speech is also available for free on the web.
I was recently a guest expert on trauma for Arise News, an international news channel for New York, London, and Johannesburg. I was asked to provide tips on how the nation can recover from this recent tragedy during the Boston Marathon.
Below is an elaboration of my thoughts from this appearance.
On a more cognitive level, our belief in the world may be challenged or shaken. I overhear people saying, "What is this world coming to?" r "We're going to hell in a hand basket!" On the most basic level, we all need to feel that the world is generally more safe than dangerous and that people are more helpful than hurtful. Without this assumption, our capacity to love and grow becomes significantly hampered, and we become more vulnerable to mental illnesses like depression, anxiety, PTSD, and even anger. Any traumatic event challenges these fundamental assumptions we need to make about the world. It is our job to remember that the world is generally a safe place, particularly for those of us fortunate enough to live in these great United States. Like I said on the news program, this tragedy was but one moment in our lives. We are supposed to respond with horror and grief. But, when that moment passes, we have to allow it to pass and realize that there have been and will be millions of moments when nothing bad happens and in fact "pockets of beauty" quoting Nietzsche emerge.
Right now, we are all mostly responding like we should. We are all a little more hyper-vigilant, ore alert, more jittery and tense. Our sleep may be disrupted and we may feel less hungry or queasy. This is our body's natural way of keeping us protected from perceived threat. We need to thank our bodies for keeping us alert for danger, but when the danger has passed, we need to help our body expend that energy (through physical exercise, crying, relaxation practices, etc) and remind our bodies that we are safe again.
One other thing that our stress response does when it is on high alert, is that it looks to identify the source of threat. It needs to find the enemy. Simultaneously, this state of alarm narrows our thinking, making us think in simplified, black-and-white erms. In another parallel process, we feel horrified by exposure to evil and want to move ourselves as far away from that as possible. We all hold within us a mix of good and evil parts. But, when something extremely evil happens, we want to simplify the world, distance ourselves from such evil, and compensate by thinking of ourselves as more good. This is what I think of when I hear interviews of people who knew this young men and can't make sense of these evil acts and the good kids they used to know.
These processes leaves us highly vulnerable for wanting to find a singular source of danger and label that danger as purely evil. In this moment, particularly when commingled with grief, which leaves us wanting retaliation as a safer, less vulnerable and helpless, state of being, we are at great risk of planting seeds of hatred, discrimination, racism, and oppression. We want to say that all Chechen or all Muslims are bad people because it makes us feel safer to just assume so and leave it at that or know who to blame and hurt for what has happened.
The key to protecting ourselves from such an outcome is to stand naked in our inability to comprehend how such evil acts exists, allow these events to wash through us in waves of fear, anger, despair, and grief, then allow them to pass, realizing that the moment is temporary and soon enough new moments will arise free from this one.
(Originally posted on drjacobham.com)
herapy is such an interesting, magical thing and there are so many ways that it can help and for such a variety of issues. It's honestly hard to describe what makes it work, and I think most therapists would struggle to summarize an answer. I’ll give my favorite answer to how therapy works, recognizing that it’s definitely not the only answer.
Most people who seek therapy struggle in their relationships with others and this struggle often reveals struggles in people’s relationships to themselves, which in turn is often reciprocally due to earlier problems in their relationships to primary caretakers. It’s as if all relationships at every interpersonal and intrapsychic level are literally fractal--that is, they echo each other at different scales of experience. Even a person’s relationship to their therapist echoes this core, fractal pattern of relating. I personally enjoy working in this way and pay careful attention to my experience in the room with another person and the moment-to-moment nuances in our interactions. I trust that what happens in the moment is a fractal of the core issue, so exploring and healing the moment will heal relationships that expand out into the real world and pierce inwards towards one’s relationship to the imagined “Others” in one’s heart and to one’s relationship to oneself.
I find that this careful, attentive listening works really well when working to heal all types of family relationships too. This approach seems to help people get out of the rut of having the same fights over and over again. Most family fights happen because people are too afraid to speak from the true place of vulnerability and hurt. Instead, they lash out and attack back when they feel they’ve been attacked. People also have a hard time acknowledging and listening to each other, desperate to make sure their own voices don’t become diminished or drowned. At other times, ghosts of relationships past, self-hate and self-criticism haunt us and distort everything we hear into the messages we most fear hearing. For instance, we hear “I wish you wouldn’t do that” as “I think you’re stupid and disgusting.” Or, more commonly, we hear “I’m tired of fighting with you” as “I hate you and I’m leaving you,” which scares the heck out of all of us!
If my approach doesn’t fit with you, that’s okay. I think the fractal nature of experience means that many kinds of therapy can heal because the healing has a ripple effect across the levels of experience. For example, a cognitive therapist might focus on uncovering and challenging destructive core beliefs about oneself or others; a behaviorist might focus on coaching specific ways to change one’s behaviors in real relationships outside the therapy room; or a psychoanalyst might explore childhood history and/or its impact on the here and now of the therapeutic relationship.
So, the most important thing to consider when finding a therapist is not what type of therapy they practice, but how they make you feel when you talk to them. All consumers of therapy know this implicitly and act on this knowing by either showing up every week or missing appointments and avoiding therapy (I wish that more of clients would express their dissatisfaction with verbal feedback, instead, so therapists can learn and become better therapists).
There is such an incredible amount of hurt that flows like a deluge across the world. It crashes through us one interaction at a time as we are hurt and then hurt the next in return. The only way to stem the tide is to actively and defiantly say “I will no longer allow this hurt to pass through me and poison me.” Then, this commitment needs to be made again and again, because the tide of hurt is big and deep. It wells around us and springs from us. But, someday, the momentum can change, such that being light becomes a little more easy, less work. I promise. Be patient. In fact, that patience is one of the first and most important acts of love and light that stems the tide.
I think the most important skill--one which is very difficult to teach--is the ability, willingness, and courage to stand emotionally naked but steady in front of another human being and bear witness to that which is unbearable. To allow oneself to be fully moved by the devastating horror that trauma represents without being overwhelmed by it.
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