In late September, 2001 I sat inside my quiet, private office with a patient I had known for many years. She looked deeply into my eyes and said: Now the whole world knows what I have felt all my life. My patient had been subjected to years of physical, sexual and emotional abuse growing up. And for years she would come to her sessions in various self-states, sometimes young and frightened, sometimes adolescent and belligerent, sometimes the poet and painter, sometimes the auto mechanic. After that session I sat with her statement resonating within me. I reached for my ink pens and drew this:
Now, almost sixteen years later, my patient is much less subject to dissociative self state changes and she no longer feels unsafe twenty-four hours a day. But what about the rest of us? Something has shifted in the awareness of those who grew up with a felt sense (perhaps naïve, perhaps just lucky) that the world is a safe place. Perhaps this is a function of our access to information. Almost instantaneously we are bombarded with images of severely traumatized populations in Syria, refugee children drowning in the Mediterranean Sea, and in the United States innocent Black men and boys murdered for simply driving cars. Now on Twitter I can easily follow organizations that report on child marriage and human trafficking and sexual slavery. And with retweeting, I can be exposed to the same horror, over and over again, hour after hour.
In November 2016 something happened in the United States that has been experienced as traumatic by greater than 50% of the American population: the election of a president who embraces hate and uses shame as a tool for persuasion and control. What happens in psychotherapy when the sense of danger, when helplessness and rage, are a chronic shared state, when the unanswered question is “how can this be happening”? I have begun to think about affect regulation, not just as an individual process, but as a community project. Session after session with individual patients I circle back to a sense of helplessness and disbelief as we witness together the dismantling of governmental social support for those most in need; as we experience together the rise of hate crime throughout the U.S.; as we worry together about the fate of our environment, locally and globally. Regardless of one’s personal political views, we are all experiencing the collective trauma of fear and hate.
Historically, community affect has been self-regulated through prayer, song and dance. W.E. Dubois wrote about the precursor to the sorrow songs of slavery:
The child sang it to his children and they to their children’s children, and so two hundred years it has travelled down to us and we sing it to our children, knowing as little as our fathers what its words may mean, but knowing well the meaning of its music. (Dubois WE, p. 120, 1909/2012)
Humming has been compared to a bird’s sentinel song – a communication that the moment is safe (Jordania 2008). Freedom Singer Bernice Johnson Reagon said: “When we sing, we announce our existence. . . . Singing is running this sound through your body. You cannot sing a song and not change your condition.”
But singing and humming are not in my psychotherapeutic tool box. So in these past months I have found comfortable alternatives. When I find myself revved up by the content of a session I sometimes pause, interrupt and invite my patient to join me in a few minutes of coherent breathing (Stephen Elliot, Respire I). No one has ever objected and many have been appreciative. I keep a Tibetan Singing Bowl nearby and that too is often a welcome interruption.
I have noticed that those in my practice who are most engaged in group actions also seem to be less depressed and less anxious. Unlike their experiences as young children in which isolation fueled helplessness and shame, groups like Indivisible foster resilience.
We all carry within us embodied memory of trauma passed through the generations. This intergenerational transmission of trauma intermingles with our immediate stressors and when unrecognized leaves us vulnerable to increased isolation. There are egregious forces around us breaking down the safety of community. While we have come to appreciate the healing power of an attuned therapeutic relationship, we need also be mindful of that relationship within a larger sense of community.
Karen Hopenwasser MD is an integrative psychiatrist in private practice in New York City and Clinical Associate Professor of Psychiatry at the Weill Cornell College of Medicine. She has been evaluating and treating adults with dissociative disorders for over three decades, with a special focus on understanding the neurobiology of body memory in clinical work. She is currently exploring the relationship between rhythm entrainment and attunement in therapeutic healing. She is the author of a number of papers which help clinicians recognize the impact of early childhood relational trauma in adult life, including “Dissociative Disorders in Women: Long-term Consequences of Violence Against Children,” “Being in Rhythm: Dissociative Attunement in Therapeutic Practice,” “Bearing the Unbearable: Meditations on Being in Rhythm,” and two book chapters, “Dissociative Attunement in a Resonant World” and “Listening to the Body: Somatic Representations of Dissociated Memory.” Dr. Hopenwasser is a Distinguished Life Fellow of the American Psychiatric Association, a former member of the APA New York District Branch Ethics Committee and was the Chair of the District Branch Task Force on the Problem of Sexual Contact in Treatment. She has many years of experience giving expert testimony in forensic cases related to the long-term consequences of sexual abuse by clergy, physicians, and therapists and has long been engaged in educating the public about trauma and dissociation.
Du Bois WE, The Souls of Black Folk, 2012, digireads.com
Elliot S, Coherence: Respire 1—Coherent breathing for health and wellness (CD)
Jordania J (2010) Music and Emotions: Humming in Human Prehistory (proceedings of the International Symposium on Traditional Polyphony, held in Tbilisi, Georgia in 2008. International Research Center for Traditional Polyphony of Tbilisi State Conservatory
Reagan B in The Songs are Free : 1991 PBS program, http://www.pbs.org/moyers/journal/11232007/profile3.html).