The Skill Gaps, a Follow-Up

There is something I should clarify about my last post, Empathy, Mentalization, and Complex Trauma. Actually, several things.

The first of these is that I made an assumption about complex trauma, which may not be correct, but that I do think was probably reasonable. I assumed that most or nearly individuals with complex trauma have someone in their immediate family with a mental illness which affects that person’s ability to empathize, mentalize, or regulate emotions. I am assuming that complex trauma is not just about having lived through repeated traumas, but about other factors that tend to go along with spending a lot of time around the kinds of people that are more likely to harm themselves or others or risk harm to themselves or others.

In other words, if your parent (like mine) attempted suicide when you were a kid, there was probably a lot more going wrong than just that. And it probably had something to do with empathy, mentalization, or regulating emotions. Because most things that make us really unhappy or really unable to function do.

In my last post, I also talked about skill gaps in mentalization. There are three types of skill gaps that can occur really. One of them has to do with understanding the minds of people you care about and are close to that have a mental illness.

Shared neural circuits for mentalizing about the self and other. a) Activation for mentalizing about self (red voxels) or other (blue voxels). White voxels denote overlap for self- and other-mentalizing. b) Common functional connectivity from shared vMPFC, PCC, and RTPJ seed regions. Red voxels show connectivity for self-mentalizing and blue voxels are for other-mentalizing. White voxels denote the overlap in connectivity for self- and other-mentalizing
Shared neural circuits for mentalizing about the self and other. a) Activation for mentalizing about self (red voxels) or other (blue voxels). White voxels denote overlap for self- and other-mentalizing. b) Common functional connectivity from shared vMPFC, PCC, and RTPJ seed regions. Red voxels show connectivity for self-mentalizing and blue voxels are for other-mentalizing. White voxels denote the overlap in connectivity for self- and other-mentalizing

I’ll put it to you like this. I have a number of skill gaps as an accountant. In fact, I really know almost nothing about accounting. However, I am not an accountant. It really doesn’t matter.

If you have no one close to you who doesn’t, for example, have BPD, then you really don’t need to understand how people with that disorder think. “That’s a whack job if I’ve ever seen one,” is probably as complex as your understanding of their inner emotional lives needs to go.

If that person is your sibling, your parent, your spouse, or your best friend, then that just isn’t going to cut it.

But the other skill gaps affect the rest of your life. They will still be there even if you decide to cut out of your life altogether everyone who is mentally ill, emotional unstable, or neuro-atypical.

One of them is understanding your own mind and how it works, how you think and feel and what motivates you. If you spent a lot of time with someone who had difficulty mentalizing (as BPDs are speculated to have), especially during your growing up years, you are likely to have trouble with it yourself.

It’s a little like learning math from someone who is mixed up about math. You may learn it, but you may also learn it wrong, or you may learn some things but not others. You may be able to do it, but not with any fluency or confidence.

When you spend a lot of time around someone with difficulty mentalizing, you may be told frequently that you think or feel something you do not think or feel, or be told you feel things you don’t feel or that you don’t feel what you do.

Because we are profoundly social creatures, we often believe what people tell us, especially if we are told it repeatedly. Even if we know it can’t be the truth. If you were a kid and just getting a handle on this whole mentalization business in the first place, you are doubly likely to believe this. You will mislabel your own feelings and motives and misunderstand how your own mind works. And that’s going to be a problem for you.

Not difficult.
Not difficult.

The third skill gap has to do with how we learn how to mentalize in the first place. And although there are a several different theories about how mentalization develops, as a completely non-expert observer, it seems to me that mostly we base our models of the mind on our own minds and on the kinds of minds we have the most experience with.

As the child of a psychopath, it’s not really very difficult for me to understand how a psychopath thinks or what motivates him. I spent a lot of time with one and it’s really not very complicated.

It took me a lot longer to understand the minds of people who aren’t disordered. I had very little experience with them.

So it may also be difficult for you to understand the minds of people who aren’t mentally ill, or who are mentally ill in a different way. And that’s going to make a lot of things just hard.

In sum, those with complex trauma can have difficulty with mentalization in three distinct areas. You may have difficulty mentalizing about an important person who is mentally ill, because that person’s mind is so unlike yours. You may have difficulty mentalizing about your own mind, because it was so deeply misunderstood by someone else for so long. And you may have difficulty mentalizing about ordinary people, because their minds are so unlike the minds of people who shaped your view of how minds work.

It’s a problem. Indeed.

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Empathy, Mentalization, and Complex Trauma

Affective (or emotional) empathy and cognitive empathy have been compared to nested Russian dolls, but I prefer to see them as distinct systems that work together to help us interact with and understand our worlds.

It amazes me sometimes what I don’t know, and what I know now that I didn’t know before.

Mados tells me that empathy has two components: an emotional component and a cognitive component. It turns out that she is absolutely right.

The emotional component allows us to literally feel what others are feeling and seems to have something to do with our mirror neuron system. It is what makes histrionic personalities so difficult to be around and can make meditating with others who are also meditating especially calming. Emotional empathy makes affective states contagious.

Cognitive empathy involves mentalization–being able to think about someone else’s thoughts and feelings–and perspective-taking. The Sally-Anne test is really a test of the very first stage of the development of cognitive empathy: recognizing that a different person with access to different information will have a different thought about a situation. Children without Autism Spectrum Disorders (ASD) have a good grasp of this idea by the time they are four years old.

Children with ASD don’t, because they seem to have delayed cognitive empathy skills, although they may have perfectly average emotional empathy. Difficulties with cognitive empathy have all kinds of other implications, including problems with developing social, language, and academic skills, because our ability to understand the minds of others impacts how well we are able to learn from them.

We notice the social aspects of ASD because social interactions are such a high priority for most of us–human beings are among the most social creatures on the planet. But I’m not convinced they are causal. Difficulties with social information processing may result from general difficulties processing sensory information that interfere with taking in and making sense of social cues.

ObstacleCourseTires1However, this post is not actually about ASD. It is about how our empathic skills work together to help us interact with and understand our worlds–or don’t.

Just as with ASD, some of the difficulties associated with complex trauma may have to do with skill gaps in cognitive empathy that also lead to a vast array of other difficulties, including difficulties in mentalization–thinking about our own minds and the minds of others.

I am involved in several online groups for family members of people with Borderline Personality Disorder (BPD), and many of the struggles new members have revolve around difficulties with mentalization–perhaps not generally, but in regards to the BPD. Most of their questions boil down to, “How is she thinking? Why is she acting this way? What motivates her?” And, “What can I be doing to help?”

Mentalization.

Understanding how someone else’s mind works, what they are thinking and feeling and why, help us to interact with others in successful ways. It is like knowing how to navigate an obstacle course. When we know how high to jump to get over the wall, how fast we can manage to run through the tires without tripping,  and how low to stoop for the tunnel, it is almost fun.

When we know how someone’s mind works, we can navigate them too. We can make ourselves understood, we can repair breaks in communication, we can provide comfort and support when others need it. When the minds of others are incomprehensible, we can’t. And it isn’t fun.

The Sponge People. Click the image to follow link.
The Sponge People. Click the image to follow link.

It is frightening.

It is frightening when we can literally feel the distress of others, but we can’t make sense of it and we don’t know what to do about it.

And it isn’t just a practical problem. We use mentalization to regulate our own affective states. When we “catch” someone else’s emotional distress, we consider their mental state to reframe the distress as nonthreatening. We use it to take action that relieves their distress (and ours). When the distress is incomprehensible, we have one less tool with which to manage it.

When have never learned to properly understand our own minds either, because those around us had disordered minds, then we are doubly disadvantaged. We become sponges, with nothing to dry us out again.

Virtual Villagers and Other Allegories

Ever played Virtual Villagers? It’s a Sims-style game where you get 5 villagers and you have to figure out how to feed them, keep them well, and build various things. It’s not fascinating, but it’s not the worst way to kill some time.

The bamboo enclosure.
The bamboo enclosure.

There are five of them. The last one, True Believers, is fairly creepy–at least for someone with a cult-upbringing (like me). You have to “convert” the “heathens.” Yeah. Seriously.

I bring this up only because the Villagers in question have been “captured” by said heathens and are imprisoned in a bamboo-looking kind of enclosure. One of the first challenges of the game is to take the enclosure down. Which is actually incredibly easy.

As far as I remember, you drop a Villlager on it, and that’s what he or she does. Starts taking it apart. If you set two of the Villagers on the task, it’s down within hours.

The prison in my head is still coming down.

This morning a neighbor came for coffee. She brought cookies. She’s nice that way. She’s also a terrifically good cook.

Was it the coffee?
Was it the coffee?

We covered a lot of ground over that coffee. Cafe La Llave must be good stuff. Or maybe it was the cookies. Whatever it was, I told her rather bluntly that I had been trafficked for sex as a child. I would talk about it in softer terms, but I don’t know how. There is simply no easier way to say it. So I told her, not the details or the stories I’ve shared in some of my posts, but the bare fact of it.

She teared up when I said that. And later, she said if I needed anything…

She’s a nice person, like I said.

I couldn’t manage to tell her, as I have said much more easily in this space, that she had already given me what I needed. Because what I need–what I think we all need–is for someone to simply be with us. And she was with me.

I didn’t say either, while she teared up at the thought of my suffering, that being able to speak about it pulls down the prison in my head. Being able to speak means that it is over. It means it is safe to speak, there will be no consequences for it. It means the prison has been torn down and the jailers have gone away.

There is nothing greater she could do for me than that.

Thank you to all of you who are with me while I tear this prison down.

Distress Tolerance: Part 2

Since I shared with you my decision to tackle my terror of writing and before that my terror of cleaning house, I thought I should let you know the outcome.

The world is a beautiful place. Oh, and I recognize my hands as belonging to me. Life is good.

It took two days to get there. Writing, it turns out, terrifies me quite a bit more than dusting the furniture. Perhaps I would have gotten there faster, but I had a cold. And coldy brains just don’t work as well.

Yesterday did not go as well as today. I was coldier. Or maybe it just took me a while to get the hang of it. But today I’d say has been a success.

I began in the same way I approached cleaning house: in 10-minute increments. But I found tolerating distress while writing is harder than tolerating it while cleaning. Not more painful, perhaps, but more difficult in a practical sense. Because writing uses a lot of the brain. And so does distress. Cleaning, not so much. You can get all choked up, dissociate, have flashbacks, start thinking about ways to take revenge on your perpetrators all while giving the sink a good scrub. Do those things while writing and you often find yourself not writing anymore.

Also, cleaning has a clear end in sight. Even though I was working in 10-minute increments, there was no defined endpoint for when I should actually stop writing if I continued to be able to get through each set of 10 minutes. Endpoints help with motivation. They keep us focused on a task. Endpoints are good. I didn’t have one, and that made it harder too.

So, today, I changed it up a little. Ten minutes first. Then 20. Then 40. Then 80. Eighty provided an end-point. If you can handle doing something for an hour and 20 minutes, you are probably good to go. Or at least that was my reasoning. And it did help. I stayed more focused. I dissociated less. I kept writing through the distress.

Interesting things happened. First of all, I was okay for eight minutes. Eight minutes into it was when the anxiety began to set in. Funny, isn’t it? I have a remarkable sense of time, although I can get lost in it as well as anyone else. Still, I know pretty well how long a minute is, how long 10 minutes is. And I imagine my mom must have had an average. Eight minutes to get up out of bed (she was always in bed), use the bathroom, head down the stairs, and into my room. From whence the screaming and throwing things began.

So the challenge became getting to the eight-minute mark and then waiting for the anxiety to subside. And it did. Eventually. Not quickly. But eventually.

What’s interesting to me about distress tolerance as a therapeutic technique is that it makes your mind cease to be the enemy. In PTSD, you are no longer in danger, but your mind continues to be an unpredictable place. Distress tolerance doesn’t change the distress, but it means the distress ceases to be terrifying. And that reduces a great deal of the feeling of overwhelming powerlessness that is the core of the problem. You still cannot stop the distress. You can’t make it go away. But you can outlast it.

I believe distress tolerance also unlinks the chains of a fear structure, so that particular triggers no longer activate self-propelling sequences of memories and thoughts that maintain an association between those triggers and terror. In that sense, and I wasn’t expecting this, it is more effective than thought-stopping (which also has its uses.)

It works because the thought and the emotions simply stays where it is, rather than getting routed to something else–say a comforting image of a loved one or a favorite place–that may eventually link back to the terror again and in that way keep the structure intact. (Since so many things do link back to terror.)  In distress tolerance, you simply stay in the same place. So that the link becomes trigger->terror->nothing. The associations don’t link back to anything that can then re-activate the terror.

As far as why it made the world seem like a more beautiful place and why I recognize my hands as being mine again, it’s a little harder to explain. And I’m tired now. I still have a cold, and it’s time to try dusting again. So that will need to wait for another day.

But you should really check out Quratulain Balouch. She’s awesome.

Tackling More Fears

Last weekend, I tackled cleaning house. Today, I’m thinking about writing.

They are the two activities that seem to frighten me the most, after taking a shower. And I think I’ve finally gotten the shower thing under control.

My mind is a funny place. Maybe all minds are, but I would hate to speak for your mind if that weren’t true. What’s funny about it is how literal it is. I seem to have grown up in a culture that expected metaphor and “deeper” meanings. But the shower scares me because I don’t want to be six and have to give a man a blow-job in there. Cleaning scares me because I don’t want things thrown at me while I’m doing it. And writing scares me for very similar reasons. It’s not really all that complicated. It’s not deep or metaphorical at all.

You might expect writing to scare me because I am afraid I will fail at it, or I think people won’t like what I write.

Perhaps all I needed was a brief knot-tying tutorial.
Perhaps all I needed was a brief knot-tying tutorial.

Well, I’m sorry to break it to you, but I have failed at a lot of things before. You have no idea how many times I failed at tying my shoe. I still have scars from falling down and skinning my knees. As a runner, I was an utter failure. Walking didn’t always go well for me either. (I had the broken arm to prove it, when I tripped in a “walking race” in second grade. I lived through that. I can live through a blank page. I can even live through 200 pages of absolute crap.

And as far as what everyone thinks? It’s nice, of course, to be liked. It’s nice to be thought well of. But let’s be real for a second here. I don’t like everyone else out there either. Why should everyone like me?

No, my fear of writing is entirely about a fear of physical assault.

My mother had two obsessions when I was growing up: cleaning house and reading (which later became writing). More specifically, that I should be cleaning and not reading (or writing).

It’s not that the house had to be clean. It wasn’t. It was, in fact, a total disaster most of the time. It was about controlling my time. She was obsessed with my cleaning. If she was unhappy about something, it was probably because I hadn’t cleaned the bathroom. Or taken out the trash.

A good book takes you out of reach.
A good book takes you out of reach.

If I didn’t allow her to control my time, I didn’t love her. And that led to screaming, and then throwing things, and sometimes real physical violence. Or suicide. The reaction looked like this: You didn’t clean the house -> You don’t love me -> I should die.

Of course, there was a deeper problem. There is some degree of depth and metaphor here. I won’t deny all of it. Cleaning represented my enslavement and the extent to which I was merely an object used to accomplish tasks–either domestic work or prostitution. In a sense, there was no real difference between them. My parents simply had different ends to which they preferred to use me. But use me they did.

So, I actually spent more time trying not to clean than actually clean. But either way things got thrown at my head.

It may be harder to see what she had against my reading and writing. She actually started it all: reading to my sister and me at night, taking us to the library every week for years and years, keeping books by the dozen all around the house. But what I did was different. Non-sanctioned. Rebellious even. It had to be stopped.

Because if I was lost in a good book or writing a really great scene in a story (according to me, at least), then I obviously had a life and mind of my own. I was more than just an object if I had thoughts worth writing down or was spending my time imagining things she didn’t even know about. My mind made me something more than merely a slave, available to serve her. It made me a human being.

That had to be stopped. And it was. Usually with a command to go and clean something. And that’s how the throwing things comes in.

Walking Away

The lousy thing about trauma, and maybe especially complex trauma, is that you find you have to keep returning to it. It is never neat, tidy, or orderly. Instead, you scrape a layer off, leave it, go back to scrape off another. Onions come to mind. But onions are orderly. Their layers come apart so neatly.

The story is important with resolving trauma. You need to be able to tell that story. But you also need to retell it. I don’t know why. But you do. A different bit becomes important, I suppose, so you have to tell it with that part told more prominently.

This is the same story I’ve told on here before. With a different bit.

I don’t like telling this story. Some stories I tell thinking this story might help someone else. This story has a value.

I don’t feel that way about this story. This story reveals to me the very worst side of human nature. It says nothing to me except that some people are simply unspeakably callous. There is nothing uplifting in this story, no indication of redemption or hope. I don’t feel brave telling it. I feel that I am doing nothing more than adding to our already considerable knowledge of the darkness that lies in the human heart.

But listen. I have to tell it anyway.

I told the story first here, in The Scent of a Lion, Trauma and the Brain, but briefly. And again, in more detail, here: The Thought of Death in the Morning Goes Well with Tea. I seem to be good at telling stories in little bits.

But here, this is another bit. After my mother hit me over the head with a chair, and I fell to the floor, unconscious, in a widening pool of blood, she turned away and walked upstairs.

I didn’t see her go, but I know that’s what she did, because I found her there later.

I was a toddler. She did not go for help. She did not check to see if I was still breathing. She left me there to die.

I have another memory of her strangling me with her bare hands. I suppose I was about five. I remember coming to on the same kitchen floor.

She would have let me die then too.

I don’t know what to tell you about that or about her. But I cannot, simply cannot imagine doing that. I can imagine being angry with a child. I can imagine losing control. I can even imagine doing something I terrible that I would immediately regret. But I cannot imagine just walking away.

My mother did.

Distress Tolerance

Distress tolerance is a component of Dialectical Behavior Therapy. It’s just the idea that there is a value in simply being with a feeling–not thinking about the feeling, not analyzing the feeling, just naming it and then being there with it.

I did a lot of that today. I cleaned my house. I like to do this on the weekends. I suppose a lot of people do.

But it’s complicated for me. House-cleaning is intimately tied up in my mind with suicidal ideation–my own, and my mother’s. Doing the laundry makes me want to cut my wrists. Dusting is enough to get me thinking about buying a gun. Cleaning the toilet is a dance with death.

So it’s tough. And some weekends I spend the entire time just trying to cope with the fallout of that, and still end up with unfolded laundry on Sunday night. It’s tedious. And for someone who prefers order and tidiness, it’s frustrating.

So, today I thought, “I’ll just do it for ten minutes. If I can handle that, I’ll do it for another ten. If I can’t, I’ll stop. “I set a goal for myself I believed I couldn’t fail, knowing that success is always more motivating than failure.

And I could handle it. Again and again, I could. I did think about suicide. I did feel I couldn’t keep doing washing the dishes or folding laundry. But I made it to the end of ten minutes every single time. My house is swept, dusted, wiped down, clean. I have clean dishes to eat with and clean clothes to wear. And it’s only Saturday. Early Saturday evening. I haven’t done this well in months.

In fact, after about 30 minutes of setting the timer in 10 minute increments, something magical happened. For the first time in my life, I felt in control of my own mind, my own feelings, my own life. I thought, “This is terrible. This is absolutely horrible. But I can stand it. I can stand my feelings. I can stand the memories. I can stand the thoughts that go with them. I can stand it all for ten minutes, and I think I can stand it for hours. I am free. Absolutely free.”

My trauma didn’t disappear. That wasn’t the magic. I still remember dishes being thrown at my head. I still feel consumed by despair at my life having no meaning or value. I still have visions of my mother slicing her wrists in front of me. None of that has changed. The magic was only being able to stand it. Because what you can stand no longer controls you.