Vicarious trauma - the hint is in the word "trauma"

Vicarious trauma in short is the trauma that you experience hearing or seeing someone else's trauma.
It shows up with similar symptoms to the original trauma (like PTSD for example).

How can it affect you if you're not the victim of the trauma itself?
I'm hoping the following might give you an answer to that.

We all have some idea of what trauma looks like: you get beaten up. You live in a war zone. You get raped. It happens to you.

But what about if you see as a child your mother being beaten up by your father? Though he's never laid a hand on you, odds are you witnessing it will leave you traumatised. It happens to someone close to you.

Or if you're a soldier, and you witness your mate being literally blown to pieces? Though you may be physically unscathed, you will experience trauma. It happens to someone close to you.

Vicarious trauma is once removed. It doesn't happen to you, you don't witness it - but it still affects you.
If you're a reporter, putting together a documentary on a genocide, you see it on a screen.

If you're a soldier, safe in your home country, whose job it is to deliver the news to parents that their sons have "died for their country", you see it in your mind's eye.

Can you see how being confronted with trauma, first hand or second hand, it then becomes only a short step to imagine what you'd feel like in the same situation, feeling the same fear?

Vicarious trauma is a "disease" of empathy - if you can see other people's pain, and if you care about those people, odds are that you will feel that pain yourself.

In my work as a psychotherapist I am sometimes confronted with stories of unimaginable suffering. They happen in the present or the past of people I care deeply about.
I can never forget them.

If I want to continue working and not to start despairing of the human condition, the worst of which I sometimes hear, I have to find a way to both acknowledge the horrors I hear, and not live them in my mind.

I have to accept that the trauma I hear about can become the trauma I feel, and seek help for it.

In order to do so, I go and see my own therapist. He helps me to find ways to give meaning to the pain I witness, and to take care of my vicarious symptoms of trauma.

The gift we give those whose pain we witness is that they are no longer alone.

What you focus on is what you will see.

No, this is not a "state the obvious" blog post - it's not about seeing what you look at.
It is about how our focus includes and excludes things from our field of vision.

In normal life, it looks like this:
My children love to spot and count yellow cars in traffic (anything really to compete with each other, but that is a blog post for another day). Though I don't participate in their game, I now notice yellow cars even when they are not with me in the car! The focus has created an awareness has created a "standing out" of yellow cars.

Let's get a little bit closer to my field of work:
Women wanting to conceive but having difficulties with it have an increased focus on and thus awareness for pregnant women and babies. They will literally "see babies everywhere" - yet the amount of babies hasn't changed of course, but they are taking a much increased notice of them.

Basically our brain filters in and out information. Things it thinks we need to see (or hear, smell etc) or which it thinks are not relevant to us. In that way, our sense of smell will stop smelling something once we got used to it (putting it in the background if you want) to ensure we don't miss any new smells (this used to be key to the survival of our species).

Our brain even goes a little bit further though in this - and that can be good or bad: our focus will also determine how we process the information we are given.

If I assume that life is dangerous, I will focus on preventing danger, and hence see it everywhere.
If I assume life is fun, I will see opportunities for fun.
Same life, same facts, different perspectives.

I was raised by a pessimistic perfectionist (my father) and have taken on some of his traits. It is easier for me to see flaws than to see the rest (i.e. I see the pimple and not the face). This is a well-ensconced focus in my life, but that I have to battle against if I don't want to sink into doom and gloom.

And this is where the interesting bit comes in - how can we change our focus, when it is usually something that is very much part of us? I can't become an optimist just by wanting it (trust me, I've tried).

I found that what works the best is to imagine the opposite. Instead of focusing just on doom and gloom, I visualise what I actually would like to see.  I imagine - yes, preferably in images, not just words - what a good outcome would be like.

It works in at least two ways:
First, I spend less time in doom and gloom, which helps.
Second, by imagining good outcomes I can often see ways to achieve those, and get started on actually making them happen.

It's the whole difference between just trying to ward off bad stuff and actively seeking out good stuff.

Just take a minute to think:
What is your focus directed on?
How do you influence your perception of reality?

Why depression is a mental illness

Surely you have also wondered how depression is a mental illness when pretty much everyone sometimes suffers from feeling down or depressed, without necessarily having a mental illness?

When sufferers or mental health professionals talk about depression, we mean clinical depression - not temporary feelings of being down or of unhappiness.

So what differentiates these from those? What - other than length of time - makes depression a true mental illness?

In my experience, clinical depression comes with a side-serve of cognitive distortion, which means thinking thoughts that just don't correspond to reality.

This is all very theoretical so far, so let me give you an example:

A person suffering from clinical depression might "think" it perfectly rational to commit suicide, as they cannot imagine a way out of how they're feeling. Yet for most sufferers of depression, the illness has both a beginning and an end, and things do get better.

Worse, a person in the depth of depression might think that it would place a terrible burden on their children to have a parent who suicides, and so think of killing his/her children too, to "spare" them.

Now, would you think that any person "in their right mind", i.e. not suffering from a mental illness, would think along those lines?

The difference between being depressed and having clinical depression is about whether we can still see our reality clearly, or whether our mind distorts them into something that a "normal" (i.e. non-ill) person would not recognise as reality.

And that is the terrifying "reality" for sufferers of depression - viewing life through a dark grey filter created by their own brains.

Well-meaning advice about getting more exercise or "looking at the bright side" just won't be helpful; they will sound to a person with depression roughly the same as "grow a third arm" - completely impossible.

Instead, try sitting with them, holding their hand, literally or metaphorically, so that at least one cognitive distortion, the one that tells them that they're all alone in this world, is proved to be wrong.

The notion of "enthusiastic consent"

In the wake of the #metoo movement, light has been thrown on different definitions of rape - clearly the legal fraternity has a different one to the sisterhood of #metoo...

Some very clever metaphors have been used to try and get across the idea of what consent looks like, and my personal favourite is this video illustrating how in the same way you wouldn't force a person to drink the tea they may have asked for, you shouldn't force sex on someone if they don't want it anymore, even if they did ask for it earlier.

Consent is such an apparently difficult idea because until now, absence of refusal was taken as meaning consent - i.e. if you don't say no, you're really saying yes. In no other area of law does this hold up: if I say "buy this car" and you don't say "no", you still don't have to buy the car - you have to expressly say "yes" in order for a contract to come about.

Somehow though, for a very long time (and without getting into feminist conspiracy theory, I'd guess that laws were mainly made by men, and rape victims were mainly women) it was considered that if you were not saying "no" - you were de facto consenting to sex.

The lawmakers eventually added that you had to be in a state fit to give consent (yes, that had to be added!!) - so no consent was possible if you were say asleep, passed out, or highly intoxicated. Some progress I guess.

It leaves the problem that, when confronted with danger, there are three possible responses dictated by our brains: fight (yes, usually the message gets through that it's not consent), flight (ditto) and freeze. Now, freeze could look to the untrained eye of a horny male like "she's lying there, not fighting back, not saying no, so she's ok with what I'm doing". He would quite possibly be wrong - she could just have gone into a frozen state.

Here comes in the notion of enthusiastic consent. The idea is that, in order to be sure that sex is consensual, both parties participate enthusiastically. You can tell when enthusiasm is present, be it verbal or non-verbal. How easy is it to just stop what you're doing unless the other one is clearly as much into it as you are!

I like to bring up the idea of enthusiastic consent in other areas than sex. It is a good yard stick on what is happening in other types of relationships as well.

For example, if you're suggesting to get married, and you get anything less than an enthusiastic response (after the potential shock), then maybe it's not such a good idea.
Or if you're suggesting a change to an employee or a boss, and you get a lukewarm "maybe" - assume the other one is not on board with the change.

Enthusiastic consent allows to remove any doubt on what is going on, any misunderstanding - which I think is the best outcome for everyone involved; and where sex is concerned, it will actually be something enjoyable *for both parties* which I will make the bold assumption is the idea for most of us in the first place!

The two main conditions for successful therapy

Have you ever wondered what helps make therapy successful?
Which are the main tools, the modalities, the therapist training that mean you will get the best results?

The answer will possibly surprise you. When research was done into classifying the factors contributing to a successful outcome of psychotherapy, the two by far most important factors were actually unrelated to school of thoughts, modalities or training!

The first predictor of therapeutic outcomes is about you, the client: it is your desire to change. It is the realisation that if you want to improve your life, you are responsible to make it happen. Mostly that translates into three options: change your circumstances, leave your circumstances or find a way to make peace with them.

Once you accept that you are responsible for your life, and no-one else, your therapy can become about how to change.

The second most important factor is the relationship you develop with the therapist. Yes, getting on well (which does not mean being unchallenged!) with your therapist, trusting him or her, having a close relationship is the second biggest healing factor.

Only then, way further down, come in factors like training, modalities etc.

So basically, once you're ready for change, seek a therapist who you can relate to, whom your gut feeling endorses and you feel comfortable with, who will still challenge you where appropriate, yet not judge you, and your therapy will be most likely to succeed.

To me, the therapeutic relationship is one of the most intimate relationships there is.
To be trusted with someone's innermost thoughts and feelings is the most sacred bond I know.
And it fills me with joy to be able to repay this trust by being there for my clients, not only reliably, but wholeheartedly.

"You spot it, you got it" - or the first rule (of thumb) of psychology

"You spot it, you got it" basically sums up the relationship of us noticing something in someone else (usually something we're critical about, but not always) and the likelihood of us suffering from the same thing.

An example: I was recently noticing the recrudescence of "mansplaining" - a portmanteau word of "man" and "explaining", which is used when a man needlessly explains things to a woman, that he assumes she knows nothing about.

And I mentioned it to a friend, that I was getting sick of men trying to explain things to me (me, of all people! LOL) that I quite certainly knew more about than they did.

Only half an hour later, I was explaining to that same friend something he knew already about, and he jokingly told me I was "femme-splaining" - and he was right.

I spotted it in others, and clearly I suffer from it myself.

This rule of thumb comes quite useful in my work. When I listen carefully to my clients, and hear them take exception to something other people, or when they talk about their "pet-hates", more often than not they just may have that same issue.

It's a powerful tool for self-analysis. Last time I admitted to myself that I couldn't stand someone, because he was such a smartypants, I also had to admit that smartypants-ness was definitely something I suffer from too...

The list is pretty endless. Not everything we dislike is also a fault of our own, but it is true often enough to warrant looking at yourself to become aware of a potential blindspot.

And it does go both ways - if you are very generous, or very kind, you are more likely to notice generosity, or kindness, in others. It is about traits that we are familiar with, but not always consciously realising that the reason we notice them is because we have been living with them.

Consider critiquing others like looking into a slightly distorting mirror - you may not be seeing your own face, but you will probably spot some of your own spots :)

The curse of face blindness

One day, when my father was still in his 20s, he was walking in Berlin, and upon coming across a man in an overcoat thought to himself "it's funny, this man has exactly the same coat as my brother!" - it turned out it was his brother...

Welcome to the world of prosopagnosia, also known as face blindness.
It seems like such a weird condition - after all, life is based on us recognising the people we know!
Indeed, for those of us who suffer from it, life can be quite a challenge, as everyone seems to take "being recognised" for granted.

The way it works, or rather doesn't work, is that the bit in the brain which normally puts all the details of a person's face together to form a meaningful picture, doesn't do that job, or at least not properly. When babies are small, they can even distinguish between faces of monkeys. By the time they are about one year old, the brain cuts away all the "useless" capabilities.

Think of it as when you see people of a different race to yours - and you struggle to tell them apart. The whole "white/black/Asian people all look the same" is a way for our brains to do only what is necessary for them - and unfortunately for face blind people, that pruning inside our brain just went that little bit too far...

I suffer from face blindness, though possibly not at the same degree than my father.
I will come across the same people multiple times, and unless I have a relationship with them, or they have unforgettable features, I will not recognise them...

I will remember your clothes, your glasses, your eyes, your nose, your hair style, but not your face as a whole. It's harder for me to recognise "pretty" people, as they tend to have less prominent features. And if you change your glasses or your hairstyle, I may get that niggling feeling that I may know you, but I won't recognise your face.

One of the hardest challenges for me is when one of my children changes schools. It means a whole lot of new faces that I cannot recognise. My trick to try and avoid offending people is to smile widely and say hello to literally every single person at the school, in the hope that this way I won't offend the people I have met before but don't know that I know...

Very often I will introduce myself to people only to find out that I have actually met them before - but they remember very well that I did, and though I will definitely remember the conversation I will not know I had it with that person in particular.

A famous example of a completely face blind person is the psychiatrist Oliver Sacks - Bill Hayes (his partner) described it very movingly in his book Insomniac City (book I wholeheartedly recommend by the way) - how Sacks would stand next to a person at a function who happened to be about the same height and build of Hayes, and wearing vaguely similar clothes, and asking that person about their weekend plans, fully convinced he was talking to his partner...

When I read that, or think about my father, I realise I am not that badly afflicted. Faces do imprint themselves in my brain after a long enough time. I recognise my family, and my friends that I have spent a lot of time with. Clients can be tricky, as I do recognise them in my office (they tend to match the names in my diary lol), but I definitely don't when I bump into them at the supermarket; but I think that is a rather good thing - who wants to be greeted by their therapist in public anyway!

So please, if I ever see you (especially out of context) and ignore you, don't assume it is arrogance or carelessness, but rather blame my prosopagnosia :)