The Language of Trauma
Downloaded by [New York University] at 12:38 12 August 2016
This page intentionally left blank
Downloaded by [New York University] at 12:38 12 August 2016
Ten- month- old Millie is sitting in her stroller as her mother talks with a neighbor.
It is hot and Millie is due for lunch and her nap. She whines and tries to turn in her stroller. Millie’s mother pauses in her conversation, peeks at the baby, and smiles reassuringly. “We’ll go home real soon, Millie. I know you are tired and hungry.
Give me another few minutes, okay? How about some water in the meanwhile? I bet you are thirsty.” Millie stops fussing and reaches with her hand. Her mother gets a baby bottle from the stroller- bag and hands it to the child. Millie settles back into the stroller cushion and suckles on the water, content to wait a little longer.
Our world and how we understand it become shaped by our experiences and our communication with others around us. Language and communication are crucial for babies and children: What is communicated (or is not) and how it is communicated literally shapes their brain and understanding. Language includes the ways we put words together as well as the intent we invest them with.
As detailed in Part 1 , communication allows us to convey information about feelings, perceptions, and concepts and to ask questions about them. It allows us to express needs and ideas in requests, queries, and the sharing of thoughts and plans. It shows our understanding of others’ communication through our own responses of voice, language, action, affect, and internal state.
In the vignette above, Millie communicates her distress and impatience.
Her mother’s language and actions reflect understanding as she verbalizes the child’s discomfort and offers a temporary reprieve. Millie is still tired and hun- gry, but her thirst is slaked and her impatience validated. We can assume from Millie’s response that she understood some of her mother’s words and that she had learned through previous interactions to trust her mother to attend to her needs. The mother’s sensitive response can lead us to infer that had Millie shown stronger discomfort or continued to fuss, the mother would have ended the con- versation, picked the child up, offered a snack, or adjusted the stroller so Millie could sleep. Millie communicated nonverbally but her mother used language and action to impart understanding and care. The success of their communica- tion likely followed previous positive exchanges.
How Trauma Affects Language and Why It Matters So Much More in Children
7
Downloaded by [New York University] at 12:38 12 August 2016
Ten- month- old Ronnie’s mother also stops to speak with a friend. Ronnie is hot and tired. When the conversation stretches, he whines. His mother ignores him and continues chatting. Ronnie whines louder. Getting no response, he begins crying.
“Cut it out, Ronnie,” his mother scolds impatiently. “Stop fussing.” Ronnie tosses his hat out of the stroller. “UGH, Ronnie!” the mother bends down to pick up the cap, glares at the infant, and continues her conversation. When Ronnie continues crying, his mother thumps the stroller’s handles, jarring the baby with each word. “Cut. It.
Out. Can’t you see I’m talking?” Ronnie startles, stops crying, and sits passively in the stroller, staring vacantly ahead.
When Ronnie stopped crying, it was not because he was soothed or under- stood, but because his mother’s anger scared him. Too young to talk, he could not verbalize his discomfort, and his mother did not help. She neither put his experience into words nor reassured him that she would soon attend to him.
Instead, her anger communicated upset at his disrupting her conversation.
Ronnie’s previous experience might have taught him that continued crying would lead to more anger. Maybe his mother’s reaction reminded him of when her rage proved painful or terrifying. Tied into his stroller, Ronnie could not remove himself from the situation, attend to his own needs, or seek comfort elsewhere. He stopped crying even as his distress intensified, and shut down. His mother’s response to his attempt to communicate his needs let him know he was a nuisance and he better stop nagging, or else.
When it comes to babies and children, the stage is exquisitely set for com- munication failure. Their comprehension is limited. They have no words or far fewer words than adults for describing their experience. They are still learning conversational rules and concepts such as time, order, and causation. Adults nor- mally shoulder much of the language burden to ensure successful communica- tion, interpreting babies’ actions and reactions, narrating what the babies are doing or seem to want, verbalizing possible motivations, etc. If the interpretation matches the child’s needs, communication succeeded. If the child’s needs are not met, the adult likely misinterpreted the child’s intent and the interaction failed.
Communication failure of itself is not a negative. Misunderstandings hap- pen, and children can learn how to recognize and fix them: They point, repeat a word, or pull the adult to show them what they had intended. They may shake their head or cry to show frustration. Older children learn how to ask questions if they did not understand, or to rephrase what they said if others seem confused.
Normal communication failure utilizes the baseline of overall successful inter- action to teach repair, creative thinking, tenacity, and flexibility. However, when that baseline is missing, communication failure can lead to withdrawal, reduced interaction, and distress.
It is possible that Ronnie’s mother had a bad day, was not feeling well, or for some reason was momentarily overwhelmed. If that interaction was an isolated event, it would not likely impact Ronnie’s development. However, if the exchange
Downloaded by [New York University] at 12:38 12 August 2016
was representative of how Ronnie’s mother usually responded to his attempts to communicate needs, his language could suffer. How would he know to label body states or feelings? How would he learn to talk about things that happened and how they made him feel? Who would he tell it too? Why would he even try?
How would he know that his perceptions were describable, that they mattered?
Language helps us think, compare, reason, deduct, and predict. Connections are initiated and reinforced through sharing all manner of experiences and sto- ries. To learn language, children need to be exposed to it through the narration of their caretakers and descriptions of things, events, actions, and concepts in the child’s world (Baron 1992, Berman 2004, de Boysson- Bardies 1999, Glea- son & Ratner 2009, Ninio & Snow 1996). As caretakers verbalize physical states and emotional experiences, children learn to conceptualize and describe: hun- gry, angry, tired, warm, dry, and happy. Bedtime stories, shared conversations, and narrative of daily events weave a growing tapestry of language for a child to draw on. By kindergarten, normally developing, well- cared- for children can use language to tell stories, negotiate basic desires, share thoughts, comment, listen, and understand communicative intents (Berman 2004, Ninio & Snow 1996).
Traumatized children, however, may find communication foreign or threat- ening. They may fear speaking about what they want or need. They may not even know what it is. Children need support the most during overwhelm, and yet traumatizing events are often when experiences were least likely to be acknowl- edged and validated, let alone explained. Caregivers may be unavailable during crises (Kazak et al 2006, Kuttner 2010, Winston et al 2002), and the trauma of neglect and abuse is often ignored or deliberately denied, minimized, and dis- torted (Heineman 1998, Pearce & Pezzot- Pearce 1997, Putnam, 1997, Silberg, 1998, 2013, Terr 1990, Wieland 2011). Trauma alters the child’s world and his/
her ability to talk about it.
Trauma Narrative in Adults
Language centers are programmed to work in calm conditions. Stress disrupts the capacity to think clearly, affects information processing, formulating, and prob- lem solving and impacts communication (van der Kolk 2014). Even relatively simple directions can be confusing or difficult to understand and/or remem- ber under stress. Stressed persons are prone to misreading and misinterpreting what is said or needed. They may find it difficult to explain what they need and can send confusing, impatient, even unkind verbal and nonverbal signals. Stress makes people lousy communication partners.
Stress affects processing and memory. It is why doctors advise patients to bring someone along to important appointments and why people bring notes to important presentations. It is also why stressed people’s sense of humor may seem dulled and what they usually find witty becomes irritating. Even moderate
Downloaded by [New York University] at 12:38 12 August 2016
stress—too much to do, too little sleep—can affect language processing, let alone the overwhelm of trauma. Conceptualization, narration, and memory often change under extreme duress, which can lead to traumatic events being encoded, retrieved, and communicated differently than everyday events (Cozolino 2006, Herman 1997, Silberg 2013, van der Kolk 2014). In addition, dissociation and overwhelm can fragment traumatic events, with fragmentation further dis- rupting the encoding of events and making them difficult to process and share (Attias & Goodwin 1999, Levine & Maté 2010, Lehman 2005, Perry & Szalavitz 2006, Putnam 1997, Steinberg & Schnall 2000).
Trauma can defy words. People who survived traumatic events often say things like “words can’t describe it,” “it was beyond words,” or “I can’t find the words to explain it.” These expressions depict how un- word- able trauma can feel. Survi- vors frequently find it difficult to explain how they felt, how they knew what they know, and why they reacted the way they did. They may not fully comprehend how things unfolded or how to describe it. “If you weren’t there, you wouldn’t understand,” they may say, “I wasn’t thinking, I just acted,” or “I don’t know how I got from A to B, it just happened.”
Affect is an integral part of communication, too. Pleasant emotions like joy, love, and connection can heighten perception, communication, wit, processing, and memory, while unpleasant emotions like terror, helplessness, and despair can have the opposite effect. When people are flooded by difficult emotions, they may be less able to understand other people and less likely to be understood.
They may overreact (e.g. panic) or underreact (i.e. detach, shut down, dissoci- ate), with both extremes affecting the ability to extract and process information.
Cynicism, satire, and metaphor require simultaneous processing of both literal meanings and implied intention, but overwhelmed people do not do well read- ing between the lines.
Trauma evokes strong emotions: fear, worry, terror, pain, rage, confusion, horror, helplessness, despair, conflict, guilt, and many more. These feelings can persist when the person feels unable to put words to what happened or feels others do not understand, leaving survivors panicked and irritable, angry, scattered, and confused. Posttraumatic narrative can be incoherent and incon- sistent. Some people may seem overly dramatic or exaggerating while others may narrate their experiences in a detached way that leads others to think they were unaffected, are lying, or do not care (Herman 1997, van der Kolk 2014).
When traumatized persons ‘make no sense’ or ‘do not have expected feelings,’
others may find it difficult to be empathetic. Traumatized people themselves may not feel connected to what happened or to themselves. Under normal cir- cumstances, being able to recognize, differentiate, name, and understand affect allows us to feel connected to ourselves and to other people and reinforces suc- cessful communication. When feelings are so overwhelming that what they bring up is incomprehensible and feels impossible to explain, ordinary words lose power. Connection and language fail.
Downloaded by [New York University] at 12:38 12 August 2016
Trauma isolates and disrupts communication. Maybe not surprisingly, it is often the sharing and finding words to communicate it that help heal and assist in making sense of what was beyond words (Herman 1997). Trauma work encompasses more than ‘talk therapy.’ The value of body therapies and work- ing through the physiological aspects of trauma is increasingly appreciated (Levine & Kline 2007, van der Kolk 2014). Nevertheless, putting one’s experi- ence in words, being heard and understood, remains part of trauma recovery.
Language facilitates the integration of traumatic events into the tapestry of life and into one’s story. In Herman’s words, it is the “testifying that brings back the victim’s voice” (Herman 1997).
The Importance of Context and Pre- Trauma Skills
When adults struggle to deal with traumatic experiences, they do so with some understanding of the world and with language to draw from. Adults may know—
at least cognitively—that though someone harmed them, it does not mean that the whole world turned unsafe. They have experience with managing everyday stressors, conflict, and disappointment, along with some sense of calm, relax- ation, and focusing. Most adults are able to understand—or at least identify—
other people’s confusing or irrational behaviors. They can draw on connections and attachment to others to get through. They know bad things can end.
Even under duress, adults may have some context for what happened—they may be in terrible pain being treated after a car accident, but they know what an accident is and that the doctors are trying to help. An injured person may know that help is likely to come, where they might go for support, that some things are illegal and who to report them to. They understand that natural disasters are out- side their control (i.e. not their fault). Using their world knowledge, adults can draw comparisons to try and identify at least some of how they feel. They might say “I was more terrified than I have ever been before,” or “this was worse than a thousand wasp- stings,” or “I felt so alone!” They have perspective and life knowl- edge with which to understand and verbalize some of what they experience.
Yet even with world knowledge and a well- developed language, trauma can be very difficult to find the words for. Adults often struggle to recall some aspects of what happened while at the same time being flooded by other aspects of it (Herman 1997, Levine & Maté 2010, Wallin 2007, van der Hart et al 2006, van der Kolk 2014). They may feel confused or that even if they tried to explain, no one would understand. Some feel that no words would work and that something fundamental in them was changed by the trauma, that there is no describing what they endured.
Healing often includes reaffirming connections to other people and using life experiences before the trauma as anchor. People may remember places they felt safe in—physically and otherwise—and ‘visualize’ those safe places to reorient when trauma memories overwhelm. They may work to release the trauma stored
Downloaded by [New York University] at 12:38 12 August 2016
in their bodies so that calm can be restored. Traumatized adults might journal or find a common language with others who endured similar hardship. They can tell their story and find hope (Cozolino 2014, Herman 1997, Schwartz 2000, Schore 2012, van der Hart et al 2006, van der Kolk 2014).
Nothing to Compare to—Early Trauma and Lack of Baseline Skills Verbalizing trauma can be difficult for people who have mature language skills and an understanding of the world. How much more difficult for children, who have yet to acquire language and who lack a full concept of the world? As a group, children have less access to emotional regulation, a narrow base of life experi- ence, and a limited understanding of context or options. A loud thunderclap may startle an adult, but it can terrify a young child who does not know what it is, what it means, or what would happen next. Because physiological regulation is still emerging in children, they often rely on others to help them regulate from panic and learn what is or is not life- threatening (Cozolino 2006, Schore 2001).
Children are intrinsically vulnerable. They can rarely remove themselves from a scary situation and may not be aware of the possibility of leaving even when it is there. They may be unable to identify that they are getting upset or scared, let alone explain what scared them. When language is either unavailable or inadequate to describe reality—let alone in posttraumatic states when language centers are suppressed—the child is left with “mute hopelessness about the pos- sibility of communicating. . . . [W]ords are both too powerful and completely useless” (Strong 1999, p. 44).
The impact of trauma on children’s connection and communication is espe- cially devastating because children develop attachment and language at the same time. A parent’s ‘word’ for something—an object, feeling, event—becomes the child’s understanding for that thing. What a caregiver says (or does not say) is interwoven into the assumptions and beliefs a child has about the world. What an adult communicates becomes the child’s reality. Without much life experi- ence to compare to, trauma can influence how a child understands meaning in ways that affects not only trauma- related material but other interactions as well.
For children, trauma may not be something outside the scope of expectation:
If it happened, it may well happen again; and so any small reminder of it can become an omen of imminent overwhelm. If trauma indeed repeats (as is often the case in maltreatment), there may be little ‘normal’ to contrast trauma with. If trauma is likely in everyday interactions, children automatically apply posttrau- matic and dissociative reactions (e.g. numbing, re- experiencing), reinforcing a cycle of anxiety, reactivity, and overwhelm.
Ami’s teacher could not figure out why the child froze anytime someone ran in the hallway. “It is just a kid running!” she puzzled. “They’re not supposed to run in the hallway, but it is not like something bad is happening.” To Ami, however, the
Downloaded by [New York University] at 12:38 12 August 2016
sound of running indicated danger, someone trying to escape. Her limited repertoire dictated her interpretation, and because she froze at the first sound of running, her belief—and dissociation—became reinforced.
Children whose lives were overall safe, with sensitive caregivers who helped them regulate distress, can use supportive experience to fall back on after over- whelm, especially if they have a healthy baseline of language and communication skills. This is not the case for children whose upbringing was difficult. This is not the case for those whose communication skills are compromised by language/
learning issues, autism and developmental delay, deafness, stuttering, attention deficits, and emotional difficulties. Disabilities not only increase a child’s risk for maltreatment and trauma (Benedict et al 1990, Crosse et al 1993, Goldson 1998, Hershkowitz et al 2007, Sullivan et al 1987, Sullivan & Knutson 1998, 2000), but they place the child at a disadvantage in comprehending, processing, and narrat- ing what happened to them, compounding the child’s overwhelm and limiting people’s ability to help.
Very young children, children with disabilities, and children who experi- ence maltreatment may have a narrow or even paradoxical comprehension of concepts. Even if the child tries to verbalize his or her experience, others might misunderstand, because their assumption about the meaning of a concept is dif- ferent. Such miscommunication can leave a child feeling confused and unheard, further reinforcing helplessness and inability to get help.
Every time Miriam’s uncle came to visit, her momma would call her and announce: “Miriam, your favorite uncle is here! Aren’t you happy to see him?” That uncle would often take Miriam on ‘special trips’ which inevitably meant confusing and painful things that scared her but she was told she liked . . . For four- year- old Miriam, “favorite” meant “the one who hurts,” and being happy to see someone meant feeling afraid, anxious, and trapped. When a neighbor asked Miriam about her uncle’s visit, the child murmured, “I was happy to see him.” When the preschool teacher asked who the man who came to pick her up from school was, Miriam whis- pered: “My favorite uncle.” She tried to communicate, but instead of getting help and being protected, Miriam received reactions that indicated people thought she should spend even more time with her uncle.
When Communication Itself Is Stressful, Confusing, and Frightening
Leigh was rescued by police when they raided the ‘crack house’ his mother and her boyfriend lived in. Both adults were under the influence when police found the one- year- old in a crib. He was undernourished and had sores on his bottom from unchanged diapers. His mother sported bruises, possibly from domestic violence.
Leigh’s X- rays showed evidence of radial fracture of his arm and what looked like healed rib fractures. Child Protection Services placed him in a foster- family, where