First published in Dutch the Tijdschrift voor Psychotherapie, 2018, 44 (2), 111-119. Re-published with permission: ESTD (European Society for Trauma & Dissociation) Newsletter_Volume_7_Number_2_June_2018, 5-12.
Sick from Trauma
by: Esther Veerman
painting: Chronically Ill – Acryl, Esther Veerman (2017)
INTRODUCTION
People who carry with them chronic experiences of domestic and/or sexual violence from their early childhood often experience many consequences of a psychological nature later in life. In addition, physical consequences are also reported in the literature and by people knowledgeable about such experiences. In this article, I wish to use the story of my own experience story the consequences of violence in early childhood on my illness (history). The question I put forward is: if attention is paid to both the psychological and physical consequences of chronic early childhood trauma and good multidisciplinary treatment is used, is it possible to reduce the consequences and reduce suffering in the long term?
I was only a young girl when I had to deal with serious abuses by both my parents. Sexual abuse by my father and physical abuse by my mother. So it was that at a young age I visited the paediatrician together with my mother. At a young age, I suffered
from a serious shortness of breath. I had to go to the physiotherapist and I called him the Knocker, because he would have to loosen the mucus by percussion (clapping).. but when I left his office, I was red all over and feeling bad. Perhaps the reason for that was rather the fact that I had to go to my father during the lunch break from school. At noon,
I walked from school down the street to the shop where my father was the branch owner. It was there that things happened that could not stand the light of day. I was only six years old. On my bike home I had no more strength in my legs and no more air in
my lungs.
Once home, I fell ill. I became nauseous and had to vomit. The emotions became much too much for me; now that I look back on it, I can tell what happened, but back then, I could not. At that time, I was merely ill. My head and body were not one during that period of survival. I felt sick, but didn’t realise that I felt so wretched and sick because of the things that were wrong within the family. For me, as a child, this was normal family life. And to the outside world, everything seemed perfectly normal. I certainly didn’t dare cry at all. I think that as a child, I tried to rub away a lot of tears from my eyes that were not allowed to be there.
Often I had inflamed eyes, or my eyes were completely closed with eczema. I also started self-harming. At first, I only scratched my shoe over my ankle a little, pushing the tension and pain away. But as time went on, things got worse. Every time things happened at night, I grabbed a pair of scissors and totally destroyed the skin of my arms and legs. No cutting but rather scraping with the blade. That pain shifted the terrible internal pain and tension, as it were, and exhaustion followed. Mother invariably continued to call it eczema. All doctors in the north of the country were visited for this reason. As soon as questions were asked, I had to see a different doctor. The abuse moved to our home when my sister left home and I got a room of my own. I was only ten years old.
Small as I was, I put the abuse in boxes in my head that were as firmly locked as possible, so that I could still go to school during the day and play a bit when possible. With a mother, who was a perfectionist and very demanding, and was also quick to lash out and
smack you if you made a tiny mistake, a normal life was almost impossible. In addition, we had to get top marks as children, and so I also succeeded in high school without ever needing to repeat a year. During this period, the abuse spread to third parties, and I
have seen and experienced a lot more that is too terrible for a child to experience.
Throughout my life, I noticed that I was extremely stiff. As a small child, I couldn’t keep up during physical education classes. For example, I remember once having to climb up a climbing frame and suddenly being horrifically aware that the gymnastics teacher
could see me from below. My reaction was terribly strong. I was maybe seven years old. I was shivering at the top of the climbing frame and it was impossible for me to climb down. He was shouting and gesturing that I had to come down. In the end I managed to
obey, although my body almost let me down and I was still afraid of crashing to the ground.
That stiffness of spread. I was already anxious about anything new. But I had a lot of trouble jumping over a vaulting horse or a vaulting box, for example. Then you had to spread your legs and I couldn’t do that. I really didn’t think about the abuse at that moment, that wasn’t available to me. But I simply couldn’t spread my legs. They were clamped together. Later on there were gymnastics teachers who dragged me
over such a vaulting horse almost by force. Those were unpleasant experiences.
The years at high school I went unnoticed. I did unconsciously send out signals, such as the selfharm that became more and more visible to the outside world. So I became the only girl to wear leggings during gym class at high school. However, no questions were asked. During English lessons, I wrote a poem in which I described a “scorned Self”,
but I remember that I really didn’t understand why I had to write down those specific words. This teacher once asked me if I felt okay and I hurried to say “okay”. That was all that was ever communicated to me at that time of my life about my well-being.
During my theology studies, I seemed to be doing very well. The fact that I left home seemed to give me some space and freedom of movement. When an unexpected, sometimes small event, smell, taste, or a person’s reaction – also called a trigger -– suddenly and unconsciously reminded me of the experiences of the past, everything could go completely wrong. An example of this was a psychology lecture, during
which a film was shown, the content of which I have never remembered since. It was probably about euthanasia or another such strong theme. Suddenly I had the feeling that I was dying and fled from the lecture hall. My heart raced and I couldn’t get enough
air. A few days later, when I had a doctor examine me and he asked me to take off my bra to listen to my heart, I was convinced that he wanted to abuse me. I became furious inside. I didn’t understand anything about good care or what was right and what was
wrong. I was completely confused. But the worst thing was that I had the feeling that my body had betrayed me: after all, if I hadn’t had a “heart attack”, that doctor wouldn’t have crossed my boundaries…
A few years later, I was pregnant with my first child – the birth was as dramatic as the pregnancy had been happy and filled with joy: I had no idea how to handle the contractions and I was also very phobic about them. The pain in the pubic area resembled too much the re-experiencing of the countless rapes I had suffered in my childhood. And it all came back like a tornado. It landed on me, as it were.
After giving birth, I drifted into psychosis, in which those images returned magnified like in a nightmare; they constantly overwhelmed me. And my body gave countless memeories back to me. Sometimes I was paralysed, and then I was completely frozen again. Sometimes I was sick as a dog and then, once more, I had huge spasms in my lower back. It was almost too much to describe. Admission to psychiatric hospitals followed, first with my baby, later without. The sorrow of leaving my child behind is almost indescribable and a trauma in itself. But, in order to get better, I also had to pay
that price. The – for me – strange symptoms continued to alternate. Often, when it was close to nighttime and the doors were locked, I got a strong urge to flee. The feeling of being locked up frightened me so much that I began to shake violently, racked with
convulsions. My legs were so tense and everything in me seemed to call out that I had to get away from where I was at that moment.
At other times I suddenly got the feeling that I had landed at the bottom of a deep well and that I could only experience reality from that deep well. In fact, my muscles were slackened and my eyes closed, and I only breathed superficially. But I could hear
what was being said to me, I just couldn’t respond anymore. Years of hospitalisations and therapy followed. In the end, after many desperate attempts to find help, I asked a specialist in the field of early childhood chronic traumatisation for a diagnosis.
He concluded that I suffered from DID, dissociative identity disorder.
Years of intensive phase-oriented trauma therapy followed. At the same time, there were also many physical complaints. Previously, when I was thirty years old, my eyes deteriorated. I had keratoconus, a serious condition that caused my cornea to
degenerate. In the end, I needed a corneal transplant in my left eye and an operation in my right eye to prevent the cornea from deteriorating further. In addition, I had more and more painful symptoms, such as severe pain in my legs and back.
As I had a long history of trauma, it was long thought that it was a mental problem and therefore, little medical attention was paid to those symptoms. A general practitioner who treated me often referred to the side effects of my long list of medications and invariably said that it was a side effect of a medicine. At that time, I ended up at the emergency department with a variety of complaints. The frustrating thing was, that because of my insecurity and fear of people in general and now also of doctors, I was not able to report my complaints properly. Frustrating for the doctor who treated me, but especially for myself and my loved ones. Often I came back from the hospital even worse than I had gone there, and then I was admitted in psychiatry.
A decade and a lot of suffering later, I met a doctor at a pain clinic, he prescribed an MRI of my lower back. There turned out to be a double hernia and a scoliosis, but the doctor said that much of the pain in my pelvic floor was trauma-related. It seemed as if the body was going to give me memories back. In consultation with the doctor at the pain clinic, I received treatment from a pelvic floor physiotherapist. There it appeared that part of the
pain problem was related to a constant tension in the pelvic floor area. But any exercise to relieve the area, such as breathing exercises, degenerated into a violent re-experiencing of pieces of my trauma history.
Shortly before, I had already gone through a process in which I constantly thought I couldn’t go to the toilet because that too was a mental problem, and I constantly blamed myself for that. The end of the story was a sudden hospitalisation with otal incontinence. What became clear to me at this stage of my life was that I had to learn to take the symptoms of my body seriously. I had to learn not to confuse psychosomatics with “triggeritis”.
In my daily life, I often notice that my speech centre, in particular, is feeling under pressure. When I experience even slight stress, I can no longer find words for the simplest things I want to explain. As soon as I experience stress, I can no longer pronounce the word because of the emerging emotion, even if it is dormant in my subconscious. It is no longer part of my frame of understanding, as it were. I no longer “see” the word in front of me and can therefore no longer give it any form or sound. When the stress is over, I can speak quickly and fully again. This is an annoying handicap that has stood in my way a lot already and so I can’t, for example, give lectures without relying on written notes. I used to think I was stupid, now I know it’s a trauma-related problem and I understand myself; this helps somewhat to deal
with this limitation.
Where I want to go with my story is this: I have received excellent integrative trauma therapy in recent years and something remarkable has happened. Previously, I regularly suffered from severe exacerbations of my asthma and regularly ended up at the hospital’s emergency department. As I have already described, I have had to come a long
way in learning to recognise the physical symptoms of my body and to understand whether something is psychosomatic or merely somatic. Previously, I just started asking doctors (especially the general practitioner) to help me determine whether a complaint is psychosomatic or somatic. After all, this may apply to some complaints, such as anxiety complaints, but also to anxiety-related complaints and some pain-stress complaints.
Luckily I now have a good relationship with my family doctor and I also dare to discuss with him more whether he wants to help me make the distinction, for example
in the case of anxiety: does the anxiety stem from anxiety attacks, or am I constricted as a result of, for example, a starting pneumonia? I realise that it is not always easy to distinguish, but I do like to be able to discuss this so openly.
In the last year, I discovered explicitly how the body has also stored and returned its own memories. For example, the doctor of the pain clinic, a knowledgeable anaesthesiologist, has drawn my attention to the great tension in my pelvic floor.
Chronic stress has often also stored itself there, with consequences for my lower back, problems with breathing, but also things that others take for granted, such as the self-determination of my lower body, with all the consequences for digestion and the
urinary tract. For me there was so much falling into place. All these strange physical complaints turned out to be largely due to stress. In addition to all these mechanical complaints, I also frequently appear to be susceptible to intruders such as viruses and
bacteria. The doctors now also believe that chronic stress has had an effect on my overall condition and has done so for many years.
In spite of all my complaints and problems, I am a staunch believer: I believe in coming to rest through the integration of mind and body, all the more because I am succeeding in integrating my traumas and making them part of my history. I believe in the importance of realising that it happened to me: as a child I had enormous misfortune. This is not just a comment but an important integrative observation that I was allowed to learn as my trauma therapy progressed. I was not to blame for all these terrible things that happened to me, it was not because I was that kind of a child, or because I was not obedient enough, or what not. No, I had the enormous misfortune of being born into that family.
Now I think: that’s the way it is, but I’m still here. When I look at the process of coming back to life, I see some common threads in my life, for which I am very grateful. My partner, who has been by my side from the beginning, who has experienced so much
with me, and is still here. As a child, I saw angels who helped me escape the trauma into a safe place. After a lot of horribly bad experiences, that at times were re-traumatising, twice in a row I found wonderful trauma therapists, who helped me and showed me
the way to safe places within myself.
Not being able to talk as a result of the trauma is another ‘issue’. From an early age, I have been drawing and painting. Often I didn’t know what the drawing was all about. They were truly unconscious processes. When I was thirteen, I realised in retrospect that I had depicted one of the perpetrators. I had depicted him in the drawing as if he had been shot. The child in the drawing is guilty of killing the offender. I had taken the blame as a child, and it became very clear to me that I had reversed the question of blame in
this way. I had felt responsible for the violence for all these years. Later on, I was always discouraged from talking about traumatisation, even during all admissions to
psychiatric units, but it felt like a violent undercurrent in my inner being that had to be removed. And so I painted what my subconscious gave me. I just put all those paintings under my bed. And I kept silent about it. Fortunately, I was able to take it all with me again later on in my integrative trauma therapy. And very slowly, I dared to add word by word to the images. That, too, was a deadly creepy process. But adding words to the unconscious processes gave me a part of my processing. And a part of the realisation of my past. It made me realise what I had experienced but also: it’s over. So this is my history.
What I manage better and better is to identify emerging stress as a result of relocations earlier, to bring it to rest and to integrate it. That goes very briefly as follows: there are image memories that I struggle with that deserve attention, often caused by a trigger. I give such an image – in my case in the form of a child part – as much space as possible by
letting the child part draw in myself or by letting it do something else that allows it to express itself. Then it becomes clear what the deepest pain or difficulty is and if that is experienced together, I can try to guide the child part to the safe place that I also have
in my head, the place with the angels. In this way I integrate the child part, with the painful memory and emotion in myself.
With the increasing integration of the traumatic relics in my own existence and the integration and rewriting of my history of existence, I get a better and better grip of who I am, but also on my whole life, both psychological and somatic. I have considerably
fewer crises, practically no more psychological crises, and sometimes perhaps as much as 70% fewer than some years ago. It cost me a lot but I am very grateful for what it gives me for now and for the future.
DISCUSSION
In the story of experience, it has become clear that early childhood chronic traumatisation can be responsible for a high dose of stress in early life as well as later in life. This stress does not stop in childhood but continues latently and continues to grow under the skin and is, as it were, stuck in the body in order to provide the necessary scores later on. Through my work for Stichting Kunst uit geweld (The Foundation Art out of Violence), I came into contact with many of my fellow sufferers. People who have reported to me that they are struggling with an unsafe childhood and at the same time are struggling with many diseases.
When I visit a doctor, the first thing I need help with is the differentiation between somatics and psychosomatics. It deserves knowledge and attention on the part of the care provider for diligence as a patient to search together for the cause of a complaint. As I described in my story, it is far from simple. Because of my fear of people in general and many negative core beliefs, I was often unable to express my complaints properly.
One problem that makes it all the more difficult is speech. At moments when the stress hits me, the ability of language stops. Meanwhile I understand from the explanation of one of my trauma therapists that it really is a problem of my brain, which is why
speech goes on strike when stress takes over, but it is a major handicap. This has consequences for any talk therapy. Every traumatised patient from PTSD to DID experiences these consequences and will often have difficulty in expressing where the pain is. This can possibly be solved with patience and time – when a trauma treatment module for PTSD has failed to produce sufficient results.
My therapist had the creativity to respond to this. In the end, it really helped me to put words to the unconscious processes. The problems with language, however, are not limited to therapy, but also play a role in somatic problems. When I go to see a doctor
and I am nervous, I can’t get my words out. To this must be added the problem of dissociation. I can suddenly be insensitive to pain when I am nervous. For example, I can be sent home with a broken foot by an orthopaedist without crutches because he
underestimated the fracture and the pain. Careful listening and the attention of both the
therapist and the physician have always helped me to feel reinforced in my autonomy and also to come into my strength. This has given me the energy to become more self-reliant, to stand up for myself and to find ways to find solutions to my problems.
Nowadays, I tell the doctor that I have a history of trauma in childhood, without going into details. This helps me to say something very briefly about my fears and provides the doctor with the opportunity to consider the reality of me as a patient and the possibility of stress or anxiety, both in the actions he or she is going to perform and the possibility of
psychosomatics in the pattern of symptoms. A multidisciplinary approach for survivors of chronic early childhood trauma could, it seems to me, be useful in order to reduce suffering and improve health. My story shows that within an integral trauma therapy, attention should be paid to the somatic side of me as a patient. At the same time,
the medical world should pay more attention to the psychological side of a somatic condition, and so the two, hand in hand, could eventually lead to a reduction in complaints.
Suppose that the lung specialist in contact with the patient and the psychologist can come up with a better treatment plan and perhaps devise a treatment path for the patient that offers better recovery while being ultimately more cost-efficient, then everyone benefits. Conversely, supposing that the pulmonologist presents a treatment to a patient and that this treatment does not succeed, could it be that a past of early childhood chronic traumatisation impedes healing? This complexity, which arises from PTSD and, in my situation, DID, and the combination of many psychosomatic and somatic problems, led me to consult with my general practitioner about whether
it would make sense to set up a case manager for my situation. Someone who would help to monitor my physical condition and would help consult with doctors in a multidisciplinary team, and would help me if I had any questions and help prevent medical errors.
Perhaps a great deal could be gained if such a case manager were to be appointed.
What I would find most ideal, but what I think has never been investigated before, is when there wouldbe a doctor within a general hospital, for example an internist, who would form a multidisciplinary team together with the treating psychologist and
general practitioner. Should I, as a patient, have any questions regarding a new complaint, I might also be able to submit them by e-mail to one of them. The advantage for me as a patient is that doctors from the multidisciplinary team would know me.
They would know, for example, that sometimes I cannot express any words and, I need time. And that from time to time, I can minimise complaints or be insensitive to pain. They can also tell colleagues about me as a complex patient. In this way, medical
errors could perhaps be prevented in the future, also with regard to the extensive list of medications.
I am not unique in this. I know I am speaking for a large group of fellow sufferers. Regularly someone will ask me how, for example, if she is traumatised, she can explain to the doctor during a physical examination that she is so scared that this only
exacerbates the symptoms. For me, the trauma therapy and the attention I myself ask for on the psychological side from the regular doctor has led to better care and a reduction in crisis admissions to the emergency department. Finally, patience and stamina are very important on the part of both the caregiver and the patient. A good integrative trauma therapy in consultation with an empathetic general practitioner and specialist could perhaps make a positive impact on the health of a person with the complex problems of early childhood chronic trauma. Faith in the strength of the human being is a prerequisite for this.
Misschien valt er veel te leren van de ervaringen van mensen met een (chronische) kwetsbaarheid.
Statement
Esther Veerman 