The human mind is peculiarly vulnerable to trauma

 

 The human mind is peculiarly vulnerable to trauma, especially when young – a blind-terror is induced which turns cognition off. Cognition ceases. The mind is ‘ill’. It pays the child not to know what is happening, or who is doing what, to him or her. This is variously described as ‘denial’, dissociation, projection, repression – what have you – the upshot is that the child daren’t look, so cannot see. Repeat, DAREN’T LOOK, SO CANNOT SEE. The child works on the malperception that “full cognition or visualisation of this event is TERMINAL”. And once the child stops seeing, and this can happen quite suddenly especially pre-verbally, then they are thereafter incapable of telling whether or not the trauma has stopped. “This isn’t happening to me” leads inexorably to the inability to say or think or believe that “this has stopped happening to me” – or even very clearly what “this” is. Two things follow. (1) The medical profession is hamstrung by it. (2) The 100% remedy for it is assured – you and I know it has stopped, and our (simple but not easy) task therefore is to persuade the sufferer that today’s reality prevails, that yesterday’s trauma is now over. But we must accomplish this without ever being either parental, or re-traumatising, both of which are relentlessly easy to do. Take (1). “Listen to the patient, s/he’s telling you the diagnosis”, said William Osler, arguably the finest clinician of the last century. But those who have been traumatised are determinedly not even telling themselves. They will swear black and blue that ‘nothing happened’, that their childhood was ‘magical’, that parents could never have been better, and how wrong it would be to breathe a word of criticism of them, and so forth. To admit otherwise is to re-traumatise themselves instantly, as easily as can any ham-fisted professional breezing insensitively in. Their only remedy against the pain of abuse, is to ‘have it NOT happen’ – so woe betide those who wish, prematurely, to prove that it did. Sadly this ‘remedy’ of ‘daren’t look, so cannot see’ which was the only one available to any small infant, is now precisely what gums things up in adulthood. So the orthodox medical approach is scuppered. It’s like a man with a broken leg, vociferously denying it’s painful, or that he has a limp – the customer is king, even when they’re obviously in deep trouble. And doctors have no licence to treat ‘complaints’ that are not complained about. But they do have a licence to link the items complained about, to earlier ‘unseen’ problems – but only, and forever, with the sufferer’s consent. This is uphill work, since it is invariably coupled with prodigious resistance from the sufferer against doing any such thing – and there you have today’s doctor’s dilemma. So a different clinical approach is required – not an easy thing to ask of a profession steeped in tradition since Hippocrates. Instead of taking what the patient says at face value, the clinician needs to ‘listen’ exceptionally carefully, to ‘hear’ the bits that are being left out, or stumbled over, and to bring these, with invariable courtesy, and scrupulous consent, to the sufferer’s attention. Never in a parental or authoritarian way, but always as an informal offering, on a take it or leave it basis. To do otherwise, is to cast yourself unequivocally into the role of the adult abuser in the sufferer’s distorted perception, and thereby reliably invite anger and rage commensurate with the abuse, here visited (irrationally) on your own ham-fisted self. The abuse did occur, despite the ‘denial’ that it did not – but more importantly, it has actually stopped, which the sufferer also actively denies. Pressing this prematurely can be disastrous if not fatal. The dilemma is especially sharp when questions arise as to whether the abuse did in reality occur, or not –the ‘false memory syndrome’ quagmire. However, in practice only the severity or otherwise of the current symptoms are relevant clinically – it’s the remnants today that matter, not precise detail of how they arose – and in all cases they need eliminating, 100%. The more severe the symptoms and the more life-threatening (which is the doctor’s prime concern) – then the more solid is the evidence for past trauma. It’s not what actually occurred, which is less important clinically, it’s what remains today from what occurred then. Here again, the absolute pre-requisite for resolving any such dilemma is a sound, respectful, but above all trustworthy clinical rapport.