- The stressful circumstances of the past summer have led to a persistent feeling of tension and heaviness.
- People with PTSD are vulnerable to being triggered by the widespread tension, signals of risk and events that replay abandonment.
- Mindful practices can be of some benefit, but knowing the limits and risks of meditation practices that engage trauma is prudent.
This is the last of a trio of posts on mindful management of what the benighted summer of '21 has presented us. It's admittedly more of a cautionary tale than a palliative one. The prevailing presence has been of uncertainty and dread — of illness (and for some, of the preventive), of weather risk (fires, floods, heat, drought), civil misbehavior threats around racial and political inequities, and helpless observation of the impact of wartime mayhem.
I've commented on the peculiar effect of this period of multiple, persistent stresses on our more archaic, "threat" neurobiology. We're more adaptive to intense, "one-off" threats, but less so to these more persistent, simmering tensions.
For 18 months or more, most of us have undergone an immersive, forced training in treading with this heavier sense of emotional tone; it's like gravity has doubled its tonic force. A mash-up of anxiety, grievance, sadness — I use the term "dysphoria" — simmers along in reaction to the heaviness.
That siege of chronic primal stress versus wearing-down human response is the main storyline for most of us. But we've also encountered some specific, acutely provocative events of this season. Amid the dreaded tone, we've also experienced some intense traumas and triggers.
The Past Summer for People with PTSD
For those wrestling with post-traumatic stress states, the summer has been a minefield. My educational exposition for patients trying to understand their PTSD symptoms includes the metaphor of the post-traumatic brain as an overbuilt defense department, often blasting well-intended but deafening responses with little regard to the true degree of momentary, personal threat.
This "wartime-style" reactivity, this triggering of intense emotional pain in the midst of a current "peacetime," causes suffering in the mildest of seasons. The current summer simmer doubles things down for the PTSD sufferer in a number of ways:
- That increased ambient tension, that heaviness, only reinforces a familiar dread in those with histories of living in that tension and its fruition into remembered experiences of trauma. Therapeutic tools in reality-testing the present as somehow safer than the past can ring hollow.
- Concrete acts of trauma — "acts of commission" — get most of the press in terms of the public understanding of PTSD. But the variety of ways that traumatic experience can be allowed to occur and recur, and/or denied, devalued or minimized afterward — "acts of omission" — can be less appreciated and attended to.
- Current events that replay that awful sense of abandonment of care are deeply triggering. Putting aside geopolitics, the sense of helplessness in witnessing Afghans, especially Afghan women, being left to an endangered future, is proving intensely provocative for some — that "omission" abandonment being replayed on an international scale.
Coping with Trauma During Times of Tension
Therapeutic responses, however well-intentioned, may never seem enough. My own approach begins with an initial query around my patient's comfort level in working with such acutely traumatic material. Autonomy is everything in this moment of re-experiencing the opposite, and thus a kind of "contracting" and boundary-setting around engagement is essential for the sake of safety and trust. A "contract" made, I pursue careful listening and validating of the felt experience of the moment, a counter to that "omission" distortion.
Taking cues from the foundational work of Drs. Vincent Felitti and Bessel van der Kolk, we know that bodily "scorekeeping" may be present, that jagged memories of trauma replayed may often have a component to attend to and understand in the heart and the body. Identification of the body/heart/head/awareness aspects of the experience can help demystify and adapt.
"Breathing awareness" into each aspect with a full belly breath (covered in my last post) is a routine that can help at the outset of and during a clinical visit. In Practical Mindfulness, I reinforce a regular troubleshooting practice of "dropping into/breathing into." It's shorthand for a mindful noting of being stuck in "neck up" meditating, and responding with opening our attention to the correlative emotional and physical experience in the moment. Meditators engaging this material on their own can and should lean on this tactic.
If a mindful move to witness body and heart generates discomfort, we can consider moving around via mindful movement practices (a few yoga poses, Qi Gong or Tai Chi movements, a simple slow mindful walkabout) to engage the physical, feel some control over the moment.
As traumatic events arise in a sitting by happenstance, some decision points arise. Can I sit with this intensity? Should I? Autonomy and self-care should prevail — we can sit with it perhaps but can always decide that it's not the moment, or get some help with the decision from a trusted peer or teacher. Building self-awareness of these radioactive moments is meant to be therapeutic, not masochistic or even recapitulating the trauma. Stopping is truly OK, an act of care.
Whether in working with others or holding our own traumatic pain, sometimes consolation is all it seems we have to give. We hope it's helpful enough. There is another variable at play: time passing. Summer will give way to fall and to hope of some lightening of the current heaviness.
Sazima MD, G.(2021) Practical Mindfulness: A Physician's No-Nonsense Guide to Meditation for Beginners. Miami, FL:Mango Publishing.
Felitti MD, V FACP, Anda MD, MS R. Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults/The Adverse Childhood Experiences (ACE) Study. AJPM Vol. 14, #4, Pg.245-258, May,1998.
van der Kolk, M.D, B. (2014) The Body Keeps the Score. New York:Penguin Random House.