Addressing Trauma in the Treatment of Serious Mental Illness

“There is no present or future - only the past, happening over and over again - now.”

— Eugene O’Neill, playwright and Nobel laureate 

My recovery from long-term psychiatric hospitalization was stymied about six years after my discharge from the VA. At that time, I was able to reach certain parts of my history and could also elucidate the despair I occasionally felt in my day-to-day life, but I was unable to speak about my stay in the psychiatric hospital and the numerous times I was in four-point restraints. 

I would be talking to a friend or peer group or therapist, and time would stop.  I would begin to picture the scenes in the hospital, but they were wordless. A paralyzing panorama of pain—the horrors of my times in restraints—would blind my consciousness while my body would flood with the sensations of horror. 

I was trapped in the “endless present,” as Judith Herman, MD, discussed in her seminal work, Trauma and Recovery. My chest would tighten, my pulse would race, and my breathing would become labored. Absolutely dissociated from reality, my mind was locked back in the ward while my body was buried under the tidal wave of physical triggers. I would emerge from the mute terror unsure where I was or how long I had been there. 

In 2002 I was diagnosed with posttraumatic stress disorder (PTSD) in conjunction with my bipolar I disorder. At that time, my recovery shifted to more somatically focused work. 

To regain control of my body and to feel safe in my own skin, it has taken ten years and countless hours of Iyengar yoga, Pranayama breathing, quitting smoking, Judo, guided imagery, mountain biking, studying trauma, therapeutic massage, writing a book, acting lessons, learning my own neuroanatomical evolution, speaking hundreds of times around the country, and a complete dietary change. 

A large part of recovery is the ability to own your life’s story. The trauma from childhood physical abuse interwoven with the secondary traumatization of the hospital experience was freezing me in place, leaving me afraid to dwell in my own mind. I needed advanced, full consciousness-focused storytelling tools to interpret the tremendous internal and external sensory reactions to my memories that distorted my entire phenomenological experience.  

The Language of Trauma gave me an operational lexicon for my lived experience to work with the clinical names of my disorders. I began to slowly find a visceral freedom when I could anticipate and interpret the tearing, hollow feeling in my stomach as I stepped deeper, cognitively and somatically, into the memories of the hospital. 

Literature provides a framework for understanding this transformation. Harold Bloom, the Sterling Professor of Humanities and English at Yale University, said that Shakespeare’s characters were “free artists to themselves” in his soliloquys. As the characters self-overheard their life’s stories, they were able to take control of their narrative and change their existential trajectories, whether good or bad. Likewise, as I accumulated more experience with the physical pains associated with the non-integrated memories that resurfaced while I told my story, I was able to eventually emerge from the restraints and walk back out into the world. 

Many individuals with serious mental illness, suicidal histories, and different trauma-spectrum disorders fear the full re-telling of their stories because the visceral sensations make them think they are symptomatic again. They confuse the eternal feel of trauma symptoms with acute illness and remain locked out of their personal experience. 

In your work as a clinician, how do you address trauma? Have you found somatic-based interventions that aid in your clients’ recovery? 

Do your clients have the existential literacy to reach the horrors of their worst times and to feel met “where they are”? Where do you find the language to help them transcend their autobiographic defects?