Institutional betrayal: Secret ingredient to PTSD


We live in the world where human frailty and pathology is viewed in individual terms. When we see sickness we imagine that the person must have some weakness in biology, faith, or behavior. Rarely do we think about the role the system or community has played in the development of that person’s pathology. This is true when we think about a person diagnosed with PTSD. We therapists hypothesize about individual factors (personality factors, early childhood experiences (a slight nod to external causes) and neurobiological risk factors) and situation factors (the frequency, duration, and intensity of overwhelming trauma events) when we try to answer the “why” of the development of PTSD in a person.

The problem with this kind of thinking is that it fails to take into consideration of known research that suggests that environmental response to an individual’s trauma experiences may be a determining factor in whether PTSD or chronic traumatic reactions form.

In the most recent American Psychologist (2014, 69:6, 575-587), Carly Parnitzke Smith and Jennifer Freyd write about the concept of institutional betrayal. Traumatologists recognize Freyd’s name as the researcher who developed “betrayal trauma theory”, pointing to the especially toxic form of PTSD caused by those who were supposed to be safe and protective. These begin to examine “institutional action and inaction that exacerbate the impact of traumatic experiences…”

How can an institution betray a victim?

When a person trusts that a system designed to defend, respond, protect, or seek justice will do its job after an interpersonal trauma, and when that system either chooses not to respond (omission) or worse, chooses to lay blame at the feet of the victim (commission), institutional betrayal occurs. Examples include law enforcement accusing rape victims of “asking for it” with their clothing, church leaders allowing offender clergy to “leave with their reputations” or refusal to investigate a case of date rape when the reported offender is an important leader in the community.

In summarizing a couple of studies, Smith and Freyd point out that institutional betrayal after a trauma experience leads to higher rates of dissociation, sexual problems, and health difficulties. This is even more likely when the trauma takes place in an environment where protection of the members is trumpeted (i.e., church or military).

What are the common characteristics of betraying institutions?

Smith and Freyd note several characteristics found in institutions at greater risk for betraying members.

  • membership requirements to define in group identity. This produces a need for members to act in ways to maintain such an identity
  • Prestige (both leaders and institutions). Prestige produces both trust and fear, dependency and power
  • Priorities. “Institutional betrayal may remain unchecked when performance or reputation is valued over, or divorced from the well-being of members.” As the authors note, maintaining reputation as a priority will lead to neglect or attack of those who challenge reputation
  • Institutional denial. Blame a few bad apples, avoid institutional blame or responsibility

Those institutions that do make efforts to prevent abuse within its community may still yet fail to respond well. They may fail to use adequate screening procedures, normalize abuse, fail to utilize or follow appropriate response procedures, punish whistleblowers, and aid cover-ups.

What to do?

Smith and Freyd argue that transparency (about past actions/failures to act as well as power structures) and priority to protect the well-being of all members will move institutions away from the risk of betraying individual members. I would argue that the shift to protect moves from the institution as a whole to protection of the most vulnerable.

Let me recommend a few resources that have appeared here in the past:

  1. Diane Langberg’s 5 part video about narcissistic leaders and the institutions they lead. She too describes systemic narcissism.
  2. Why some spiritual leaders abuse (and systems allow it)
  3. Narcissistic systems
  4. Resources to combat narcissism one person at a time

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Criticism of Biblical Counseling: Are Joyce’s Concerns Valid?


Katheryn Joyce has recently published a long post about the rise of Biblical counseling and the concerns some have about the movement [read it here].

Most people who have thoughts about counseling and Christianity tend to fall into one of to categories: Those who oppose biblical counseling as dangerous and those who oppose the various versions of Christian psychology as shallow and full of humanistic ideology. Very few people try to maintain identity in both worlds. If you have read my “about me” you will find I’m one of those who does accept the label of biblical counseling and Christian psychology (more on this below)

I encourage both proponents and opponents of Biblical Counseling to read her essay. Let me even take the liberty to suggest some starting questions to keep in mind as you read. While the essay may not answer the questions, having them in mind will keep you from solidifying stereotypes of either sides.§ If you are inclined to reject biblical counseling, consider these questions:

  1. Where might I find a more thorough history of biblical counseling and its various permutations?
  2. What main biblical counseling author voices are missing in this piece? [Note that the mentioned ACBC was, until recently, known as NANC (National Association of Nouthetic Counselors)]
  3. What failures in Christian psychology movement(s) led to the need for a biblical counseling movement?

If you are inclined to defend biblical counseling, consider these questions

  1. Even if some of the bad examples of biblical counseling do not represent you or the heart of the movement, what aspects of the movement may support or encourage some of these distortions?
  2. How might you better communicate “sufficiency of Scripture” to outsiders?
  3. Does biblical counseling seek to eliminate symptoms or improve spiritual responses to symptoms? How might it better acknowledge the body when talking about the causes of mental health problems?
  4. Where does fear of “integration” hinder the maturation of biblical counseling as a movement?

Indeed, these questions have already been asked and answers given in a variety of locations. Readers unfamiliar with biblical counseling should start with websites such as this one, CCEF, ACBC, BCC, and the Society of Christian Psychology to find further and deeper readings on related topics.

Where the Concerns are Valid

Not acknowledging benefits from psychological research. Joyce notes that a good biblical counseling session looks a lot like a good professional counseling session. Why? Well, it is obvious that change happens best in the context of kind, compassionate relationships. Why the similarity? While it is true that psychotherapists didn’t discover empathy, it is true that psychotherapy research has expanded our understanding of the best way to encourage trust relationships in therapy. In addition, some of the cognitive, affective, and dynamic interventions developed from these models are used within biblical counseling. I have absolutely no problem from biblical counseling deriving benefit from interventions developed in other models of therapy. I only desire biblical counselors or acknowledge that benefit. It is clear Jay Adams benefited from Mowrer (and said so to boot). We can do the same. We can admit that Marsha Linehan has revolutionized our understanding of how we work with people exhibiting symptoms of borderline personality disorder.

Emphasizing false dichotomies. Joyce quotes Heath Lambert in this piece (near the end),

“I’m concerned [that] if we say, ‘Oh my goodness, people with hard problems need physicians and need a drug,’ we’re going to lose much of what the Bible has to say about hard problems.”

The quote above is in the context of dealing with difficult or serious mental illness. He worries that if the church creates two categories of problems (normal and special), those with serious problems will no believe that the bible has things to say about those suffering with suicidal ideation or schizophrenia. It seems that some biblical counselors take a negative stance on psychiatry and medical intervention because they fear doing so will hinder the work of the Spirit through the bible. I would argue that this dichotomy does not need to exist. I agree that the bible speaks to everyone, whether they are having difficulty or easy problems. I don’t think that use of medications or medical practitioners has to hinder pastoral care. The message that others get when we suggest that medical intervention need to be avoided is that somehow it is less spiritual to seek a medical intervention. This is patently false. Now, not every medicine is worth taking. Some may create more problems then they solve. But that fact should not cause us to lump all professional/medical care into the same category.

Where the Concerns are Overplayed

Heath Lambert gets it right when he claims that all counseling models will fail, due primarily to the quality of the practitioner. Biblical Counselors do much work that is commendable and successful. Joyce’s piece may suggest that most biblical counselors are ineffective and incompetent. This is not true. Matthew Stanford suggest he has never seen a biblical counselor do well with difficult cases. That may be the experience of my friend, but I can attest to seeing biblical counselors working well with people with serious personality disorders, delusions and other difficult mental illnesses. Now, the truth is, these counselors have succeeded because they did not follow the stereotype and reject learning from professional psychology. Further, these same counselors did not take “sufficiency” to mean that they could only use the bible in considering how to respond to their clients.

Take a moment and read her piece. Review the questions above and keep an open mind to both sides of this story.

[§ I have written on the relationship between Christian psychology and biblical counseling in the Journal of Psychology and Theology, volume 25, 1997. You can buy that essay here.]

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Does living in urban settings increase the risk for mental illness? A complex answer with more questions


I think most recognize some of the inherent stresses of urban life, especially if you add poverty and racial discrimination to the mix. Of course, there are stresses that exist in rural and suburban settings, but some parts of urban life can be quite hard. Being anonymous in a crowd, the amount of violence, the pace of life, higher cost of living are just a few of these stressors.

So, are those who live in urban settings more prone to mental illness? Some doctoral student in Sweden looked at the association of Schizophrenia, population density, and neighborhood deprivation. What did he find?

Our results therefore suggest that it is not the adverse neighborhood conditions that cause the morbidity. Instead, it seems as if there are familial selection effects that draw high-risk individuals into densely populated/socioeconomically deprived neighborhoods. In other words, the same factors that explain residence in such neighborhoods also explain the increased risks for psychiatric morbidity. link to article here.

Does this make sense to you? Certain factors draw (or keep?) some families in deprived settings and those same factors explain increase mental illness risk? What would these factors be?

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Responding to Accusations of Racism: Confessing the Sins of our Fathers (And Our Own)


The news and social media seem to be all about race these days. Comments (not necessarily conversations!) range from criticism of police to criticism of the Black community. And surely there are plenty of reasons to criticize. And notice how it is so easy to identify and name the sins of those who are not us! And when others point out our sins, we tend either to get defensive or tell a story. Neither response gets us to where we need to go!

Pointing out the sins of others (individuals and groups) fails to promote healing and reconciliation. As Jesus calls us, we must start with our own log before removing the speck in the eye of the other (Matthew 7:3f). And our own log exists beyond our own specific misdeeds. We must also acknowledge the ways we have participated in and benefitted from the sins of our “own kind” (culture, ancestors, etc.)

Being Nehemiah

By all accounts, Nehemiah was a godly man. I suspect he was born in captivity and so therefore not culpable for the sins that got Judah carried off to Babylon. He was suffering, a servant to a foreign king). And yet, he was moved to confess the sins of his “ancestors” (v. 1:6) as his own. Later, when Ezra reads the law, Nehemiah and the rest hear it then confess the sins of Israel starting with the failures to obey God in the wilderness (chapter 9). They do not call out the sins of their captors (which are evident) or even their detractors but choose to stay focused on their own failings. Not content just to confess, Nehemiah and the returnees sign a covenant and make promises for specific and objective changed behavior going forward (chapter 10).

How might this apply to our current situation? Can those who are white (no matter the economic class) confess benefits of privilege not available to many of our brothers and sisters of color? Can we do so without deflecting to the flaws and sins of those who respond sinfully to racializations?

Can we acknowledge the massive impact of hundreds of years of discrimination and why it makes sense that resulting poverty, destruction of families, and hopeless still show up today? Can we own our sins with the detail shown us in Nehemiah? Can we covenant to be different? Will we call our families and communities to be different?

Maybe then we might be free to point out the sins of those who are “other.” Until then, let us let the Holy Spirit be the one to teach “them” about following Jesus.

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Why Oppressed People May Not Jump At Chance For Freedom


Ever wonder why those who experience systematic abuse and violence don’t jump when they get a chance for freedom? Consider the abused teen choosing not to reveal the abuse to an inquiring teacher but rather stays in the abusive home in silence. Consider the victim who refuses the help of a friend in order to leave a domestically violent spouse. What is the psychology that supports these responses to oppression?

Brilliant Mhlanga has written a short memoir of his experience of being from an oppressed people group in Zimbabwe. Under the guise of “independence” his people and his family suffered tremendous violence. Family members were raped and murdered in grisly fashion. He labels what happens a genocide (from 1980-1987).

Here’s how he describes the impact of this systematic oppression (emphasis mine, British spellings his)

The psychology of oppression, then, becomes a phenomenon derived from the state where the oppressed, given their existential experience, adopt the attitude of ‘adhesion’ to the oppressor (ibid: 45). Freire adds that under these circumstances the oppressed cannot consider their situation clearly and objectively in a bid to discover themselves outside the spectacles of their oppressor. As discussed earlier, the oppressed rationalise and internalise their suffering. Their state of mental warping makes them appear as walking symbols of conformity. Such conformity makes them reject their enlightened brethren whom they tend to perceive as ‘trouble makers’. To them anyone who advocates change of their state of being is likely to bring them more trouble, as they cannot know the likely outcome. They fear change. This is the state of people who have lost a sense of hope in their full potential without the help of the oppressor.

Notice some of the features of the oppressed:

  • Identity tied to oppressor
  • Belief that one cannot exist outside this relationship (fear of being in relationship, fear of not being in relationship)
  • Internalize suffering (blame self)
  • See those who would fight for their freedom as dangerous (the devil you know may be better than the one you don’t know)
  • Reject change as dangerous

Now these features are not found in everyone who is abused but they are worth noting. Those who would want to help the oppressed must consider these challenges and develop interventions that do not automatically trigger the fear reactions. This might include,

  • Identifying self-blame and raising doubts
  • Giving freedom to control response to oppressor (not coercing leaving oppressor)
  • Identifying possible future
  • Validate change as scary

Quote: Mhlanga, B. (2009) On the psychology of oppression: Blame me on history! Critical Arts, 23:1,106 — 112

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Trauma education by txt msg? Therapy support by txt msg?


This week I came across Journal of Family and Community Ministries (free subscription required) describing the use of text messages (160 characters or less) to trainees in Rwanda and Kenya. The trainees, having received face-to-face business education, then received one text message each business day for four weeks. 4 of the text messages each week contained a local proverb used to remind and/or enhance the business education they received. Each Friday they received a text containing a multiple choice quiz question to see whether learning was taking place. This pilot study seemed to provide a “proof of concept.”

Having read the article, I began to think about two applications, sustaining trauma healing training and supporting ongoing therapy efforts.

Sustaining Trauma Healing Training

We all know the experience of attending a great training but then finding months later that we have forgotten some important concepts—or can no longer explain them as well as we would like. Life can get in the way and we lose the ideas and skills we wanted to retain.

For the last several years I have been involved in providing conference-based training to counselors and caregivers in Rwanda. Our focus in to “top-up” knowledge and skills related to trauma recovery and other related topics (especially domestic violence, child abuse prevention, addictions, etc.) Each time I am impressed by the quality of the participants and the ability to overcome personal and logistical challenges to do the work they do. But some of our topics touch on pretty new or controversial material that may not be as immediately usable by our participants. One possible solution to this problem would be to use existing proverbs (or modify a bit) and send as reminders of ideas learned. It stands to reason that these short reminders might help solidify learning. In addition, it may also help maintain connections between trainer and trainee as well as trainee and trainee between annual meetings.

Supporting Ongoing Therapy

Most counselors have the experience that their clients “get” a new skill in session only to “forget” it later in the week. What if clients could receive short texts reminding them to practice a skill, or reminding them a thought that they wanted to remember? For example, if a counselor had a specialty dealing with anxiety disorders, clients could choose to sign up to receive a daily text reminder to use common or remember key truths.

Life tends to push out what we are trying to remember. Those who journal sometimes review old writings and remember anew something that they really wanted to retain. A text message might just might provide this kind of reminder and keep the learning fresh and present.

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GTRI 2014: Day 12 Kigeme Refugee Camp


July 12, 2014. Kigeme Refugee Camp to Kigali

For all who travelled with us, our visit to the refugee camp was moving in many ways. We saw deep poverty and yet deep resilien

Heather with her new friends

Heather with her new friends

ce. The following observations are from Heather Drew, a counselor and one of my GTRI students and who begins her tenure as Fieldwork Coordinator in my seminary department today! Please welcome Heather and check out her blog as she is a gifted communicator in her own right.

Today was our last full day in Rwanda. We woke up in Butare, got one last cup of the best coffee I’ve ever tasted at a lovely coffee shop called Cafe Connexions, then rode our bus to a UN refugee camp in Kigeme. Around 20,000 Kinyarwandan speaking Congolese

Kigeme camp children

Kigeme camp children

refugees live in this camp, 12,000 of which are children, we were told. The abundance of children was immediately apparent to us as we were greeted by dozens of sweet smiles peering into our bus, waiting for us to climb out. Some of us took photos of/with the children and showed them the photo (they love that). Stan The children followed us around like we were pied pipers. The parents followed us with their eyes, and greeted us kindly. The camp was made up of rows upon rows of small mud houses with metal roofs – living spaces the size of a small American living room – containing 6-8 (or more) family members each. Our group wove through the narrow, red-dusty walkways between houses, climbing up slippery hills with the help of our small chaperones. They taught us some additional phrases in Kinyarwandan, showed us their beautifully-made and efficient water collection/filtration system, and held our hands. The EUG_7154children who could speak a few words in English were eager to do so. The ones who knew no English spoke to us without any words, showing us their homemade toys constructed with old bottles and broken pieces of things. It made me realize that the less a person has, the more resourceful and creative they become. This is a very prevalent characteristic throughout Rwanda.

At the base of the hill on which the camp sits is a meeting space where our team met with several leaders within the camp who lead trauma healing groups with fellow refugees. We were traveling with our friend Harriet Hill, one of the writers/developers of the Healing Wounds of Trauma material put out by American Bible Society, which this group has found so useful. (This book has been translated into several languages and is effectively used to facilitate around the world.) I had greatly anticipated this day, and in the moment the depth of it was not lost on me at all; here we were sitting in a room with about 50 Congolese refugees who use this book to lead healing groups in one of the most trauma-impacted areas of the world with Harriet Hill, the woman who had a dream over a decade ago to develop the material. It was extremely moving.

Leaders/facilitators gave testimonies about the groups and about personal healing, and presented questions they had. One person shared, “We are all traumatized…This material heals us and then we can help others heal.” Another shared, “During the genocide, so many of us – on both sides of the conflict – had hearts like animals. The Bible takes away our animal hearts.” Not all of these testimonies were ones of “arrival,” however. A few shared how they are still in the midst of the long healing process. The truthfulness of this impacted and inspired us.

After their testimony time Phil, Diane, Harriet, and their two leaders were invited to speak. Remarks were encouraging and thankful. Harriet Hill shared how much it meant to her that they have such bravery to share the comfort they themselves have received from Christ. She also shared Psalm 126, words that resonate with their stories. Finally, at the end of the meeting, we shared Fanta and

Zenko with Marianne Millen

Zenko with Marianne Millen

snacks together (a tradition of hospitality in Rwanda), then we said our goodbyes – even to Zenko, our dear new friend, which we were very sad about! – and boarded our bus for a 2 hour ride back to Kigali. I tried to focus on taking in the breathtaking beauty of the country as we made our last drive, because no photo can capture it.

Our final night was spent at East African Villas in Kigali. This was a hotel in Rwanda managed by a lovely Christian man called Ezekiel who was wearing a Georgia Bulldogs shirt when we arrived, which we enjoyed. We rested and enjoyed hot showers (a luxury I will no longer take for granted) during the few hours before dinner. Then we settled together in the dining room, ate our final Rwandan dinner feast, then Phil initiated our final team debriefing & sharing time.

We all shared 3 words that we each felt best expressed what we had learned in Rwanda. Among the things shared: new meaning of “celebrating the recovery of life” and also of “groans that words cannot express,” what it means to embrace Jesus’s invitation to “watch with Him,” the privilege of carrying people’s stories with them, how impactful people’s eyes and testimonies were, how much courage we saw, how much desperation we saw and how that was pointed at God in many cases. It was a much-needed time of sharing. To my knowledge, there wasn’t a dry eye among us.

We ended our night by taking a few group photos on the balcony.

GTRI 2014 Team

GTRI 2014 Team

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GTRI 2014: Day 11, Muhanga to Butare/Huye


July 11, 2014.

We ended the Community of Practice at noon and said our goodbyes. The morning consisted of a short devotional comparing the good and the false shepherd described in John 10. We explored how helpers may end up becoming “hirelings” due to burn-out and

Community of Practice

Community of Practice

loss of vision. After the devotional, our tables each became case consultations with caregivers discussing their hard cases and receiving encouragement, support, prayer, and a bit of advice. In a number of instances, caregivers brought up the issue of those who have mixed parentage (Hutu/Tutsi) and the struggle to deal with their identity. I and others have noted that this group has been far more vocal talking about the different “tribes” where previous groups have rarely even mentioned these groupings. It makes me wonder whether this is unique to this group or whether there is something going on in the country that makes it okay to discuss identity.

After our goodbyes, we traveled south for 2 hours to the university town of Butare. Butare is the home of the National University. First stop in Butare consisted of an ice cream at Sweet Dreams just down the road from the Shalom Guest house where we are staying (known internationally as the project with the female drumming corp). Our purpose here is to meet with Anglican Bishop Nathan Gasatura and some of the pastors/leaders of his diocese to discuss the trauma recovery needs. Bishop Nathan has been a friend and attended some of our previous training. Diane spoke a bit about “talking, tears, and time” and the process of healing through trauma. We had a good dialogue where one question was raised, how can a Hutu counselor help a Tutsi victim (or vice versa)? I was thankful that Baraka Paulette, the new president of the new Rwandan Association of Christian Counselors, was present as she answered in a very beautiful way, putting all at ease. Though our time was short, we squeezed in a bit of singing and dancing in the cathedral.

Before our meeting, a few of us purchased locally roasted inexpensive Rwandan coffee and an espresso at Café Connexion across the street from the cathedral and guesthouse. This cafe was not something most would venture into in the United States. It contained dingy walls, a couch and a couple of stuffed chairs, a shelf full of brown bags of coffee, a large coffee roaster and the center of the room was a small desk with an espresso machine. Yet, this was possibly the best coffee I tasted on the trip. [the return trip the next morning and bag of coffee brought home and now gone supports this opinion!] After dinner, many of us walked down the dimly lit main street in the dark passing the university. It was good to walk and good to deepen relationships with fellow GTRI mates.

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GTRI 2014: Day 10, Muhanga


July 10, 2014. Centre St. Andre

Thursday, Day 2 of the Community of Practice with the Bible Society of Rwanda. Already we are seeing deepening relationships. Last night many Americans and Rwandans sat together in the dining area talking and getting to know each other and revealing deep stories, stories of courage, pain, and hope. Precious times.

On day two of the Community of Practice we began with a short devotional considering Jeremiah’s lament. Barbara Shaffer and Carol King led a training and discussion of the problem of domestic violence. This is a new chapter in the Healing Wounds of Trauma materials. We discussed how much of a problem it is in Rwanda, why women stay, and how we can help both victim and abuser.

DSC_0307In the afternoon, we did another teaching (Carol and myself) regarding the problem of suicide. It appears that most Rwandans believe that one who commits suicide is automatically going to hell. In addition, the family is often shunned. This seemed a very entrenched belief and so my raising doubts and questions resulted in very spirited debate. While we also discussed how to help the suicidal person and how to help the family members, I left them with the encouragement not to speak for God and since no verses speak to the future of suicide persons, they ought to be careful to put words into God’s mouth.

We ended this conference day by giving the Rwandans an opportunity to have a session for their own care. We can see the weariness on their faces. Baraka led a care for the caregiver session while the GTRI team met to process what we were hearing and seeing–the heartache and the resiliency.

Monique (R) with Souvenir

Monique (R) with Souvenir

We had the privilege of listening to Monique’s story of surviving the genocide as a teenager and God’s subsequent call on her life. The story is too precious and hard to share here beyond a few words. She survived when family members around her were executed (shot) and fell on top of her. The killers left the pile of bodies, not knowing that she was not killed. Just prior to this event, she had read Psalm 91 and heard God speaking to her about her own future when she read verse 7,

“A thousand may fall at your side, ten thousand at your right hand, but it will not come near you.” 

She has gone one to become an evangelist for Christ and a helper of the hurting. I can attest that she has a gift that few have. And I will never read that verse again in the same way

As the previous night, many of us stayed up quite late deepening relationships with new and old Rwandan friends. Looking over the dinner area, I saw heads bowed in prayer, attempts to speak in French, cackling laughter, and the sharing of food and drink. Such a beautiful sight.

Tomorrow will end our COP and we will move on south to Butare.

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Brooks on journaling about emotions


Friend Jeff McMullen pointed out a recent David Brooks op ed in the New York Times. (Read it here). While I’m not sure I agree fully with his journaling/not journaling point he says something very important about the timing of writing one’s emotions after a traumatic event. He says,

When people examine themselves from too close, they often end up ruminating or oversimplifying. Rumination is like that middle-of-the-night thinking — when the rest of the world is hidden by darkness and the mind descends into a spiral of endless reaction to itself. People have repetitive thoughts, but don’t take action. Depressed ruminators end up making themselves more depressed.

Then later, this important distinction between immediate processing of emotions and later processing,

We are better self-perceivers if we can create distance and see the general contours of our emergent system selves — rather than trying to unpack constituent parts. This can be done in several ways.

First, you can distance yourself by time. A program called Critical Incident Stress Debriefing had victims of trauma write down their emotions right after the event. (The idea was they shouldn’t bottle up their feelings.) But people who did so suffered more post-traumatic stress and were more depressed in the ensuing weeks. Their intimate reflections impeded healing and froze the pain. But people who write about trauma later on can place a broader perspective on things. Their lives are improved by the exercise.

David points to some research that exists that suggest CISD is unhelpful for some participants. Some are made worse. Yet, narrating one’s trauma in the broader context of a life tend to see a reduction of symptoms. The difference seems to be whether the focus in on life or mostly on the trauma. Trauma in perspective is the goal. Just reviewing trauma may in fact strengthen the traumatic reaction rather than weaken it.

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