A few years ago, I was standing in Central Park admiring the fall leaves. It was one of those lyrical moments of oneness with nature. Until our dog, whose leash I was holding, decided that she would do her own communing with nature by chasing yet another squirrel. She went right, my right knee went left, and then it snapped. She didn’t catch the squirrel. I limped home.
That’s the story of trauma. In a nanosecond, abstract risk can be transformed into an assault that injures us psychologically and/or physically. Dealing with my knee has been a journey that has taught me a few things about trauma in all its various forms.
1. Diagnosis Matters. “I am a healthy, active person,” I told myself. “This isn’t really a big deal.” “I am just getting old.” “It will just take time.” “Who needs doctors?” And so, I did my yoga and alternately experimented with ice and heat, rest and exercise. Some days my knee was better, other days worse. After too many months to count, I finally succumbed and went to an orthopedist who diagnosed my knee. I had a torn medial collateral ligament (MCL). Some of my homegrown efforts were helping. Some were making matters worse. The specific injury has specific evidence-based treatments, and within days of following the appropriate protocol, my knee started to get better. The same is true with psychological trauma. Correct diagnosis of the problem matters. It helps us identify what really happened, and it provides direction for care and recovery. Minimizing and denying are common when we experience psychological traumas, but like my knee injury, such behavior has a low probability of getting us the care we need.
2. Getting the Right Care Matters. It took me way too long to admit to myself that I had something going on that was beyond my coping playbook. This is true for most of us with mental health problems, too. A large percentage of people never get help, and for those who do, it can take years of living with distress and dysfunction before we finally seek help. For my knee, getting the right help meant having a shot at recovery. The same is true for emotional trauma and mental health care. Not all therapies are the same. In fact, clinicians not trained in trauma therapy can actually make things worse. Of course this is true, but many people think therapy is therapy. It’s not. When it comes to trauma, getting the right care, which depends on getting the right diagnosis, is essential. The American Psychological Association recommends Cognitive-Based Therapy for PTSD and Trauma-Focused CBT for children with trauma histories. The Columbia PTSD Research and Treatment Program provides evidence-based trauma care, including programs specifically designed for veterans and their families.
3. Managing the Negative Chatter. Once I got my knee diagnosed and started proper treatment, I found that the hardest part of getting through the pain of recovery was the negative chatter in my head. “I am never going to run again.” “I am too old.” “How pathetic I can’t even make it down a flight of stairs.” This self-talk is exhausting and defeating. The same thing happens to us when we are traumatized emotionally. “I am never going to do XYZ again.” “I am too XYZ.” “How pathetic I can’t even XYZ.” It sounds really simple, but one of the best coping strategies I employed was calling up a set of mantras during my training to get me through the pain. My favorite was reciting the names of all of my kids and nieces and nephews to the rhythm of my running – in age order, by family. With four kids, twenty-one nieces and nephews, one great niece and three great nephews, it kept my mind busy. Similar strategies can help us manage the negative chatter that can be part of the experience of emotional trauma as well.
4. Bundling. Recovering from my knee injury hurt a lot. Trust me, I have a high pain threshold. The deliveries of my first two children were natural childbirths (my twins were another story). The pain associated with regaining strength and mobility in my knee was so bad that sometimes I just wanted to cry. And then I read an article about “bundling.” So simple. The strategy is to save something you really, really like and bundle it with what you would rather avoid. From then on, following my most painful training sessions I had a massage. University of Pennsylvania Professor Katherine Milkman has written about using bundling strategies to help us maintain exercise routines (Check out this article on bundling: Holding the Hunger Games Hostage at the Gym). Bundling can be an effective coping strategy whenever we are struggling with things we would rather avoid, including traumatic injuries regardless of whether the roots of the trauma are physical or psychological.
5. The Trauma Will Never Not Have Happened. Psychotherapy can make a lot of things better, but it cannot undo the traumatic event. Same for physical therapy. I have done a lot of work, and my knee is much better. I can even do the stairs if I hold the railing. But the trauma is still there. Some days more than others. My journey has been one of accepting that the traumatic event is now part of my story. Again, an apt metaphor for psychological trauma – whether its physical therapy or psychotherapy, the work of recovery is not about changing history but rather about shaping how that history will impact our future.
A year ago, I thought I would never run again. A week ago, I ran a 5-mile leg of a relay marathon with my son, his girlfriend and her mom in Big Sur (very hilly, beautiful landscape: think bundling). Our team name was Happy Feet. Happy, indeed.