Lakme

lakmeI have 200 rupee eye liner from India. It’s a nice brand: Lakme. But it’s different from what I’m used to in the US. It is black, for one. You can’t find brown mascara in India and so I bought black eye liner, thinking maybe they should match. The pencil is much, much softer, so that it goes on in a thick line regardless of how thinly I try to apply it. Mainly, I don’t.

I realized last night, putting it on for our farewell dinner with the Minister of Education, that it is made that way because that is how Indian women like their eye liner. When I do wear it, I need to change my paradigm for how eye liner should look. And I can do that.

Meanwhile, I felt like a whore. Specifically, I felt like a seven-year-old child being trafficked for sex. Because they did that: dressed me up in pretty dresses, applied heavy eye-make-up and let the cameras roll.

I felt that way because that happened. Internally, there’s a crush of both belief and disbelief. Because of the extent of my denial about my childhood, these kinds of experiences have felt to me like evidence that I’m over-reacting or histrionic or even crazy. But this is just how memory works.

 

Advertisements

Why we have flashbacks: the somatic marker hypothesis

ventromedialEvidently, it’s all about the ventromedial prefrontal cortex.  I had to read this sentence 3 or 4 times before I understood it, but it seems to express the entire occurrence of flashbacks very neatly.

“The ventromedial prefrontal cortex is a repository of dispositionally recorded linkages between factual knowledge and bioregulatory states. Structures in ventromedial prefrontal cortex provide the substrate for learning an association between certain classes of complex situation, on the one hand, and the type of bioregulatory state (including emotional state) usually associated with that class of situation in past individual experience.”  Bechara, et al. Emotion, decision making and the orbitofrontal cortex.

The hypothesis being described is the somatic marker hypothesis. This hypothesis specifically claims the following:

“When subjects face a situation for which some factual aspects have been previously categorized, the pertinent dispositions are activated in higher-order association cortices. This leads to the recall of pertinently associated facts which are experienced in imagetic form. At the same time, the related ventromedial prefrontal linkages are also activated, and the emotional disposition apparatus is competently activated as well. The result of those combined actions is the reconstruction of a previously learned factual–emotional set.”

So, I think that pretty much sums it up.

What’s interesting, of course, is that although having traumatic material activated in that way is something akin to torture, people who don’t do this, who have lesions in this area and aren’t able to activate associations between experiences and somatic states make terrible decisions for their lives generally. In a gambling experiment, they continue to place their money on bet that over time will lead to greater losses than gains. Even when they know that this is happening, they continue. Apparently, you need that little nip of fear in order to follow through on making a better decision.

So, while trauma memories suck, the normal tendency to recall previous experiences in the body when facing current experiences is generally a good thing.

A Confusion about Words

David Vetter, 8 years old. Baylor College of Medicine Archives.
David Vetter, 8 years old. Baylor College of Medicine Archives.

Years ago, my therapist said something about my beginning to feel safe at some point in the mystical future. I suppose she was hopeful and thought this would make some kind of difference or being important to me in some way.

I didn’t really believe her, and it didn’t seem like a realistic or important goal.

I am still very aware of the dangers in my life. I’m not sure that will ever go away. It’s like I looked over the edge of the cliff at some point, and I now know how far the drop is. But it doesn’t really stop me. It may slow me down sometimes, I’m not sure. But generally, the risks seem mainly acceptable–acceptable enough that I’ve chosen to keep on adding more.

I didn’t know what she meant.

It’s begun to occur to me that “safe” doesn’t really mean an absence of danger. Our lives will always be dangerous to a greater or lesser degree. None of us can keep ourselves packed in cotton forever, and we could live like the boy in the bubble did, but I don’t think he would have recommended it to us. We all know that’s no way to live.

Safe doesn’t mean no one and nothing will ever hurt you. There is always something that can, and from time to time it will.

But there is this other thing, that might be what she meant and that is simply having the support you need to get you through life. It is having enough warmth and affection, enough good intentions, and enough advice from people older and wiser who know better than you. Those things aren’t safety in a literal sense, but it is safety in a felt sense.

There is another word I think I’ve been confused about and that is worth. My therapist has mentioned that as well in the same kind of wishful way–“when you feel more worthy…”

But when you’ve raised to think about worth in terms of economics, as only being about a measure of utility, and the idea of “deserving” as being about something earned, then worth isn’t a simple thing. It isn’t even a desirable thing. Being worth more only means more people have more reasons to harm you.

There is this other thing that has to do with just being a person.

We saw one of these. It was cool.
We saw one of these. It was cool.

I was out with a friend the other day. We went to a museum. She’s a science-y person, and I have very few science-y friends. So this was a rare opportunity for me to go and look at something science-y with someone else.

We spent most of the day looking at bones. It was fun.

I often have the sense when I’m around other people that whatever I say should have some merit. There should be some special reason someone else should listen to it: it should either be something the listener doesn’t know or hasn’t thought of yet, or it should be witty and funny and entertaining. In other words, it should not just be whatever garbage falls off my brain and out through my mouth.

There’s something to be said for holding yourself to that kind of standard. In a committee meeting for example, that kind of thinking is priceless. If everyone did that, meetings would never last more than an hour–no matter how complex the topic. We would all get the work done lickety-split and get to go home. Sadly, I found very people do.

Nonetheless, if you’re out with a friend looking at bones, a little garbage might be okay. In fact, it might make someone feel more connected to me. They will think they know more about me, and also be comforted by the fact that what falls off of my brain and out of mymouth is no more sparkling and brilliant than what falls off of their brains.

So I lowered my filtered. I said trivial things. I said boring things. I said whatever came to mind.

And my friend listened politely, even with interest.

That is worth.

Photo credit: Pfinge
Photo credit: Pfinge

It was given out not because I was so fascinating or brilliant or charming, but because I’m a person, and she’s a person. And basically people like other people. And it also helped that we both enjoy looking at bones and wondering things like whether walruses spit out the clam shells they’re eating or poop them out or what. It helped as well that I care about other people and I have some moral standards, because that’s the kind of person she is and who she prefers to be around.

And I am just going to stop there. Because I want to think about that last statement. I want to think about it for a good long time.

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.

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.