Trauma-Sensitive Mindfulness, a review

TRAUMA-SENSITIVE MINDFULNESS:

Practices for Safe and Transformative Healing                                               DAVID A. TRELEAVEN

Thank you for writing this, David.

So few people speak of this—almost no one—how mindfulness meditation can go awry for some of us and what to do when a previously stable, nourishing practice requires regulation.

PTSD with dissociative aspects plunged me into a ten week kundalini wormhole during mindfulness meditation in 2002, and I can attest to the thoroughness and care of David Treleaven’s new book, Trauma-Sensitive Mindfulness.

“Mindfulness is a process of enhanced self-regulation.” Brilliant.

What’s amazing about Trauma-Sensitive Mindfulness is how recognizable all its referenced books, studies, and citations are, (that I had to find for myself,) and how much comes up for me as I remember finding and reading them, and the conferences I attended to meet the authors and researchers—and where I was in my journey then. Having Pat Ogden explain the “window of tolerance” in person with all her remarks and the Q&A is ingrained.

It is gratifying as well to find the interventions that my therapist and I used laid out in this book, for others to use, organized.

I appreciate the design of Trauma-Sensitive Mindfulness. I especially like the configuration of the Modifications. Another of the book’s strengths is its emphasis on diverse cultures and backgrounds and larger systems of oppression. 

This is not a science book and I don’t object to David’s simplification of the neuroscience. I think the book’s References and Endnotes provide clarity. I would only add a few comments specific to the book:

  1. I found reference to Allan Schore’s work notably absent in David’s book, where Allan’s Affect Regulation books were essential for my understanding of implicit vs. explicit memory, and gave me hope that early impaired attachment could be repaired.
  2. I took exception to the flashback-halting protocol, although I may mean “flashback” in an exclusively experiential way, which would make a difference, i.e., my Parts never remembered, they only experienced. They invariably became annoyed when interrupted by the kind of questions in the protocol, and then everything would stop.
  3. It seems that R. C. Schwartz’s Parts in the IFS model are in fact identical to my Parts in the DID model, not that it matters. It seems to me in retrospect that my therapist was doing family systems therapy at the end when my Parts all talked to him, before integration.

Eighteen years on, my mindfulness practice continues strong.

(TRAUMA-SENSITIVE MINDFULNESS: Practices for Safe and Transformative Healing,                 DAVID A. TRELEAVEN. W.W. Norton & Company, 2018)

Canadian Geese

Annie Jackson 1950—2017

Mary Oliver says in Wild Geese:
Whoever you are, no matter how lonely,
the world offers itself to your imagination,
calls to you like the wild geese, harsh and exciting—
over and over announcing your place
in the family of things
.

4th Floor Window

Zazen is a fluid thing where distinctions never match my actual experience. The cat climbs onto my lap, circles into the curve of my ankle and settles. I sink into whatever this is. This unhappy unknowing.

Metta for everyone, to be well, please, to be peaceful and at ease, to be free…There is no time; or an eternity. My experience cannot be got at—the fundamental emptiness of all dharma. I sit. Each passing moment barely exists.

A thump. My cat leaps. My fourth-floor window is filled with a snagged balloon—a happy face! —staring back into my room with deep humor. Perfect, a perfect metaphor of the free-floating anchor point for our illusions. I realize anything is possible because it cannot be pinned down.

I can be happy knowing this wisdom.

Back in the Dark, Part two

I tilt my chin up, also my ears, and lift my eyes toward the birdsong from where I stand on the Expo platform. No trees. An old-fashioned telephone pole, a crow standing sentinel, a smaller auburn streaked bird sweetly chirping below…so urban. It strikes me like a prickling of needles, the sweet singing, the naked pole, the muscular corvus, the rush of air from the train behind me hurtling toward the ocean, and I understand that my alternate identities, my Parts, will never fully integrate the way I expected. There is no tidy ending, tied up in a neat bow, as Lee Gutkind’s editor rather insisted for my piece in his anthology. I will always and forever be multiple.

It’s time to embrace this, I say out loud, but it sounds false, embrace. What do I really mean?

For ten months, since the medical trauma of the invasive C-T with the rectal contrast, the recurrence of PTSD and dissociation has been real. I thought the integration of my Parts was woven so tightly that it would take an enormous traumatic event to fragment my sense of self, to pull us apart again. Not so.

Rather, it seems that great healing did occur for my five primary split-off Parts and they did mostly merge into my primary self. But that’s not the whole story. I still dissociate. There are still other Parts that protect me when I need them. And it’s funny that I didn’t know that.

Catherine, you are not normal.

You will never be normal.

Don’t try to be normal.

Just don’t.

 

Hope

The two bald toddlers are cancer patients. There are pizza boxes spread all around the end of the hospital bed, surrounded by IV pumps, on the hematology-oncology ward of Children’s Hospital. The main patient is two years old; they are both in flowered dresses, and joyfully eating pizza from paper plates. They have wide, happy smiles on their faces. Even slightly jaundiced, they are the brightest lights in the room. The girl in the middle of the bed is the primary patient. The other girl is a patient-friend from another bed. They are living life fully in the midst of uncertainty.

In the 2013 photograph, hope is perched on this toddler’s face at the arrival of the unexpected pizza party. I saw an embodiment of hope itself in her face, and I told myself that would be true even if she hadn’t lived, since I didn’t know how the story ended.

I looked on her blog recently and learned her cancer relapsed three years later—now. She had just started kindergarten. She has just finished her first round of combined immunotherapy and chemotherapy. I say to myself, what was it that I experienced with that happy pizza photograph? Was it real? Where is hope, MY hope? It felt like it was quashed…

My nihilism is a membrane away.

That is exactly why I’m so inspired every time I witness patients and families choosing to live life, moment by moment—celebrating birthdays, music, stories, food, and each other when others around them are focused primarily on how many days remain, not on the day at hand. The hope of the present joyful moment is not easy in the face of overwhelming odds. It inspires me every time because I can’t do it on my own.

When I read her family’s blog, I realize they can’t either. They have back-up, they have other people.

That’s the point, I think, that we have people to pick up the slack when we falter; we hold each other. And we have unexpected parties to remind us we’re living when we’re dying.

Back in the Dark, Part one

A routine C-T with contrast. Three kinds of contrast. No inner alarms have gone off. When the pain hits me, when the technician becomes my perpetrator, I make myself as still as possible. My breathing becomes tachypneic, extremely fast and shallow. I have no control over it. I bite my tongue hard to keep quiet, to remain compliant, to try to overpower the other pain—which I can not. I keep biting down. The technician says, “Take a big breath in and hold it,” and a big breath is impossible. I take a minimal breath and hold it, the best I can do. Later I think of how dogs and cats—and small children—breathe so rapidly when they’re in pain; that’s how we know they’re in such distress. When the technician removes the pressure, I can breathe deeply again, but I can only speak in a whisper and I notice how submissive I have become, timid, and dissociated. Still? Is my trauma not gone? Am I still that person?  I’m not actually afraid, my fear is held in another part of me. My terror is still held there. I had thought it was gone. Just this little trigger: pain and helplessness at the hands of a good person doing a diagnostic test, and I am back in the darkness.

I’m thankful I restarted topiramate a few months ago to block my flashbacks, because this would have been much more intense and prolonged without it, and I more deeply at risk.

Yahrzeit Letter

My father was a disturbed man. It is not his death I mourn when his yahrzeit comes every year; it’s something else. This is a complicated grief. Today his yahrzeit brings up less terror and more sadness as I trust his absence more.

This year I was surprised to receive my yahrzeit notice from my former synagogue, although we haven’t been members since we moved away before my father died. I recall these yahrzeit notices for my parents as both helpful and annoying. Helpful because the Hebrew dates change each year on the secular calendar and it’s hard to keep track of when to say Kaddish. Annoying because of what I’ve perceived as the lie in the assumption that I’d want to honor my father’s life. What do they know about it? I’d think, conflicted.

This is a thorny, complex grief.

I read this year’s letter carefully, with new eyes, and I see that it’s offering me comfort and peace. I need this. I need comforting.

It’s been eight years since my father’s death, fourteen since my mother’s. More than that, in fifty years of adulthood I have never said how much I need to be comforted. Not even to myself.

My former synagogue remembered to say this to me in their yahrzeit letter, remembered that I lost something this day, and asked me to remember this is also a time I can feel embraced and comforted.

“Why would they send you that letter, all of a sudden, out of the blue?” my friend asks. “Maybe it’s your father, offering comfort.”

“Wouldn’t that just take the cake!” I say, but I consider his outlandish words.

The world is far more baffling and convoluted than I can conjure. Such a thought challenges everything—even forgiveness would be obsolete. My friend must be toying with me. He’s becoming woo-woo, or at the very least, spiritual.

And I do it, I imagine a world larger than terror and lacerating pain and meanness and helplessness.

What if the letter was my father, offering comfort?

Of course it wasn’t. But what if?

This expanded view is mind-altering, greater than self.

Oddly, it comforts me.

 

No Crying Allowed

We all stand and sit in varying postures of disquiet, some on high stools around tables, others on low cushioned chairs, some up at the bar overlooking the country club greens, and one or two even order drinks.

Am I the only broken person who has come to Jerry’s memorial? No. I look around. We must be many frazzled people, mostly related, to have traveled to this remote place to stand here and express so little loss. We are upbeat. We laugh at the jokes and funny stories that Jerry requested. This is what he wanted, what he told Annie.

Dan used to talk about how no one cried when his little sister Vicky died of a mild case of measles back before we had vaccinations. Vicky was eight. Dan was a teenager and he was scolded for crying at Vicky’s funeral where virtually the whole town turned out for this beloved little girl—neighbors and friends and teachers and aunts and uncles and cousins, and strangers even, all heartbroken and stoic—and not one tear for their great loss, except Dan’s.

Above all, don’t disrespect Annie, I say to myself Saturday, holding back my feelings, following her plan. I’m sincere, but I don’t tell a joke, I haven’t the heart for it. Sorry, Jerry. I hug Annie. I attempt peace with some sibs, coming from my disheveled place, feeling raw, not exactly sorting reality from unreality and wondering if they can.

Dan had told me: “All those Germans in my family stood around dry eyed and strong jawed and told me to pull myself together, to stop being a sissy. I knew they loved Vicky, they delighted in her! But showing feelings was verboten, and I was not like them.”

It turns out Jerry fought in Korea.

“No! You were a baby!” I tell Jerry when I learn he was in Korea. “Dan had to lie about his age to get the army to let him go to Korea.”

“So did I,” says Jerry.

Sort the bodies, no crying allowed.

I feel an escalating anger as the weekend progresses. Jerry was here and now he is gone…They are all gone. Jerry. Vicky. Her parents: Emma and Skip. Dan.

It flashes through my awareness: the teenage boy sobbing at the loss of his little sister; the eleven year-old boy crying disconsolately for Dan after the twenty-one-gun salute, after the flag is folded and presented to me, when his body is lowered into the ground at Golden Gate Cemetery.

Thank you, Mark.

One day long ago

“One day a long time ago,” I tell my granddaughter, “when my father was only two years old, he wandered away from his house and yard, he went right down the sidewalk and he walked for a long while until he was lost and he didn’t know how to get home, so he began to cry. A policeman saw him and said, ‘I’m a policeman and I can help you,’ and he took my dad to the police station. He was only two, and he didn’t know any English, only Swedish, so he didn’t know what the policemen were saying to him and they didn’t understand him either. But it was a very small town where everyone knew everybody else, so they figured it out and called my dad’s father. And it was his two-year-old son that he thought was safely at home. When he got to the police station, guess where my father was—he was sitting on the very high counter in the front and eating an ice-cream! And that’s how the police helped my dad when he was two years old and he was lost.”

This is the first time I’ve told my four-year-old granddaughter this story, or any story, about my dad. “Did this really happen?” she asks.

“Yes, it’s a true story and it happened almost one hundred years ago.”

I have no explanation for the tears that fill my eyes. They baffle me.

Flight

The little blackbird catches my eye, hurtling purposefully toward the slender tip of a spiky desert agave to my left. He’s going to smash into the side of the building, I think, but he snags the top of the succulent—an arrow landing squarely on target—and swings around to perch on his fragile peak. Youth.

My grinding joints have slowed my walk enough to notice this bird’s acrobatics. I imagine flight, how it feels to ride the updrafts from the ocean, across the wildlife sanctuary, to where our high-rise condos make an aerial playground for winged creatures. I sit with the soaring sensation for a while.

I recall split-second agility with a whiff of nostalgia. Crouching, lifting, skipping, running, taking the stairs two at a time, not stopping to catch my breath, loaded with bags and books and babies.

Sadness. No more skidding to perch atop highest branches. Burdened by stairways, tethered to constant mental reminders. Turn off the stove. The keys are in my hand. Stay present. Feed the cat. I remind myself to clearly know what I feel. And I wonder, as I slow down to let my husband catch up, what it means to accommodate another person’s decline. To walk in their shoes? What does it mean to be self-aware? Sadness.

It comes to me that I didn’t really want to know my father. I was too frightened, even as I searched for his humanity, when I tried to draw him out in his last days. I wanted him to see me, to see the actual me, not the child he manipulated. I couldn’t see him through my terror.

No wonder flight has been second nature until now, smashing into the side of the building.