*That is an article from the Spring 2024 concern of Contentment Journal.
By Jeff Jernigan, PhD, LPC, BCPC, FAIS
Early Tuesday morning, earlier than workplace hours, the telephone rang. Glancing over, noticing who it was, I picked up the telephone. My good friend was asking if I might assist him with a affected person session. Odd, this time within the morning, to get a name from Chuck outdoors of even his workplace hours. Curious and a bit involved, we started a dialog.
Malcolm is a 91-year-old WWII fight Veteran who adopted up his navy service later in life with a 30 plus-year profession in New Orleans as a policeman. His household was having him evaluated for dementia. They had been moderately involved about his sudden withdrawal and isolation from a extremely energetic senior way of life. He was more and more depressed, had bother with short-term reminiscence, and was susceptible to indignant outbursts and mood tantrums from seemingly out of nowhere. None of those signs had appeared beforehand and got here on like a thunderstorm virtually unexpectedly. Malcolm had bother sleeping and complained about desires and nightmares holding him up at evening. Fatigue set in, together with foggy pondering.
Chuck didn’t assume this was dementia for a number of causes however wished to make sure. Malcom’s historical past indicated that he had weathered WWII and his police profession fairly properly with some post-trauma stress, which was addressed on the time with good outcomes, and had skilled no additional issues in an in any other case idyllic life. A few of Malcom’s disturbing desires had been about horrific experiences from these perilous years. So, might or not it’s post-traumatic stress and even post-traumatic stress dysfunction? If this was the case, why was it taking place now after a long time of no issues? There didn’t appear to be any obvious triggers concerned, and he had by no means talked about these experiences in any respect, ever. Therein lay the clue.
Earlier than we go additional, allow us to speak about post-trauma stress and post-traumatic stress dysfunction, in addition to suppression and repression. Folks usually consult with a demanding workday or week, describing themselves as feeling “burned out.” All of us perceive this expression as signifying how worn out they really feel now. Generally, after an extended, worrying, and probably traumatic interval, some will describe how burned out they really feel: exhausted, can’t sleep, poor decision-making, quick mood, and so forth. They might imagine they’ve post-traumatic stress dysfunction. That is most likely post-trauma stress and never post-traumatic stress dysfunction. Medical post-traumatic stress dysfunction is recognized utilizing a number of steps showing over a interval for adults and kids, not via merely figuring out a troublesome and worrying situation.
The place stress and trauma have brought about harm however don’t qualify for a analysis of post-traumatic stress dysfunction, it’s thought-about a situation versus a dysfunction.1 This situation nonetheless wants therapy and should embody suppressed reminiscences. Nonetheless, post-traumatic stress dysfunction will encompass repressed reminiscences as properly.
Suppression and repression are associated however very completely different phrases. Suppression is a voluntary response technique for concealing outward expression of experiences related to robust feelings.2 These reminiscences are pushed away however not forgotten. Repression describes reminiscences which can be pushed away and completely forgotten. That is an unconscious strategy of excluding experiences, reminiscences, or ideas.3 These are the thoughts’s manner of defending us from trauma when there’s not sufficient time or alternative to stabilize or heal. Repressed reminiscences are usually not gone; they’re nonetheless there. Suppression acts to make reminiscences much less vivid over time, whereas repression retains probably the most vivid reminiscences.
Suppression weakens undesirable reminiscences via sustained discount of neural reactivation.4 This reduces the shutting out of undesirable reminiscences and helps clarify why suppressed reminiscences might be triggered extra simply than repressed reminiscences. Repressed reminiscences are locked away. Nonetheless, this discount in suppression over time makes the emergence of repressed reminiscences extra probably as time goes by. For Malcolm, this was an issue. As time went on and life grew to become much less busy, there got here a time when the thoughts was prepared for therapeutic, and reminiscences, nightmares, and really vivid experiences so actual Malcomb felt like he was reliving an expertise started to hang-out him.
This doesn’t imply there aren’t any signs when suppression or repression is concerned. They’re simply more difficult to determine and affiliate with trauma. Signs could also be current however not readily related to something that occurred so way back in somebody’s life. That is probably when consideration is directed extra towards what may be the issue within the current moderately than the previous: melancholy, anxiousness, and dementia grew to become suspected causes for Malcomb. When there isn’t a apparent trauma concerned, it turns into much more troublesome to diagnose post-trauma stress or post-traumatic stress dysfunction.
Trauma finds its manner into our lives all through our lives. Coping with the suppressed or repressed reminiscences round trauma might be troublesome if there isn’t a precise reminiscence of the stress or trauma in any respect. This will contain the fetus within the womb because of the mom’s traumatic experiences5 or via modified DNA as a result of parental trauma experiences handed on to kids and grandchildren. There could also be no cognitive reminiscence of precise trauma, however the results are nonetheless handed on.
Hostile childhood experiences lengthy forgotten might be triggered in adults a few years later with no clues as to why stress and trauma-related signs are displaying up now. When somebody has skilled a big loss, for instance, the grieving course of could grow to be what known as sophisticated grief. It appears the individual can’t get past their grief irrespective of how a lot time has handed. This loss could have triggered repressed reminiscences relating to the deceased. That is very true if the loss was as a result of surprising suicide.6 Lack of a enterprise, a house, or a relationship the place somebody’s competency and self-criticism are acute can set off repressed reminiscences.7 Generally, a traumatic sense of disgrace and guilt in childhood might be sufficient to repress reminiscences past aware recall.8 There are numerous the reason why there could also be a delayed onset of post-trauma misery, and having a historical past of the person might be essential to unwrapping the thriller. 
Stress remains to be stress, whether or not it’s acknowledged or buried deep in our consciousness. That is one other manner of claiming whether or not we acknowledge the place the stress got here from, it nonetheless impacts us. It doesn’t matter if the stressors occurred way back or extra just lately. The excellent news is that late-onset stress and trauma situations might be handled in the identical method as stress and trauma accidents might be handled within the current. What could also be completely different is post-traumatic development. Submit-traumatic development has two parts: the pure strategy of restoration and the event of resilience that happens after preliminary therapy, and the self-care plan designed to capitalize on pure restoration processes deliberately. Malcomb has to take care of the repressed reminiscences as if they only occurred and develop a self-care plan that displays the truth of beginning over in some respects. Then there’s the inevitable self-recrimination he offers himself for not seeing this sooner.
All restoration begins with energetic listening, serving to the individual course of verbally their expertise. To not extra, however to place it into perspective and put together for the following steps. Guaranteeing diet, train, and sleep are usually not an issue, and checking to make sure significant relationships and a way of objective are usually not issues is important. Reliving repressed reminiscences might be paralyzing, and reassurance is vital. Generally, rebuilding one’s self-image and worldview could also be wanted. This can be a course of and never an occasion, a journey from the place the occasions passed off to the place the individual is now, with therapeutic alongside the best way. Malcomb might be okay with good assist from buddies and medical or psychological wellness assist as wanted. If you’re that good friend to somebody, make sure you pay attention along with your coronary heart.
References
- Diagnostic and Statistical Handbook of Psychological Problems: American Psychiatric Affiliation, Fifth Version, 2013 pp 271-280.
- Muhtadie, L, Haase, C et al, Emotion, 21(2): 405-418, 2021.
- Berlin, H, Kock, C, Protection mechanisms: neuroscience Meets psychoanalysis. Scientific American, 20(2): 2009, p16.
- Kreston-Meyer, A, Benoit, R, Cognition and Mind Science: Max Planck Institute for Human Cognitive and Mind Sciences, Germany, Mar 30, 2022.
- Cozolino, L, The Neuroscience of Human Relationships: Attachment and the Social Mind, 2nd Ed: Norton and Firm, March 2014.
- Levi-Belz, Y., Interpersonal facilitators of sophisticated grief and melancholy within the aftermath of suicide loss: The mediated roles of suicide-related disgrace and guilt. Suicide and Life-Threatening Conduct, July 2022
- Brott, Ok., Veilleux, J., Inspecting state self-criticism and self-efficacy as components underlying hopelessness and suicidal ideation. Suicide and Life-Threatening Conduct, April 2023.
- Lopez, R., Esposito-Smythers, C., et al. Relations between discrimination, rejection sensitivity, detrimental have an effect on, and decrements in problem-solving potential following social rejection: An experimental investigation. Suicide and Life-Threatening Conduct, Might 2023.