by Lisa McLean
How would you live if you were able to live the life you choose, if you lived without fear?
Dr Deborah Lee, Head of Berkshire Traumatic Stress Service and South Central Veteran’s Service in the UK, asked participants to reflect on this thought provoking question during her recent Australian workshop and keynote address at the University of Queensland’s Compassion Symposium in September, 2018.
My own response to this question did not relate to physical courage – despite having a fear of heights. I did not imagine suddenly taking up sky-diving or abseiling, or tightrope walking. Instead, I imagined what it would be like to live without social fear - to not worry about the judgement of others, and whether or not I would be accepted and valued by them. I thought about how it would change the choices I made if I no longer worried what other people thought of me. It was clear, my life would be quite different!
As Dr Lee explained, the fear of how we are perceived by others has an evolutionary function. We are highly social organisms and the threat of being rejected by and disconnected from other members of our group results in us perpetually monitoring our place within the broader social system.
We Are Wired for Connection and Belonging
So what does this mean for people who have experienced interpersonal trauma or as Dr Lee framed it, those who have been “hurt and harmed at the hands of others”. If we are wired for connection and belonging, how do we make sense of experiences that involve other members of our social group, especially those who are closest to us, when they act in ways that violate our safety, freedom, and dignity.
Unfortunately, the way many people who have been harmed by others make sense of this experience is to blame themselves, and to carry with them a burden of shame and self-loathing. This leaves them feeling alone and disconnected from others. When you believe you are shameful, it is easy to assume that others will think the same.
Complex Post-Traumatic Stress Disorder
Experiences of interpersonal trauma can lead to the development of Complex Post Traumatic Stress Disorder PTSD). The 11th edition of the International Classification of Diseases (ICD-11, World Health Organisation, 2018) defines Complex Post Traumatic Stress Disorder as “a disorder that may develop following exposure to an event or series of events of an extremely threatening or horrific nature, most commonly prolonged or repetitive events from which escape is difficult or impossible (e.g., torture, slavery, genocide campaigns, prolonged domestic violence, repeated childhood sexual or physical abuse).”
Dr Lee highlighted the sobering reality that consistent with this definition, complex PTSD is entirely preventable. It only exists because another person (or people) made a choice to cause harm, quite often during formative periods of development, resulting in physiological and psychological changes to the way someone perceives and relates to themselves, others, and the world around them.
These experiences can leave those who have been harmed with debilitating symptoms, including the re-experiencing of the traumatic event/s in the form of flashbacks and nightmares, avoidance behaviours to reduce exposure to any reminder of the original traumatic content, and hyperarousal due to chronic activation of the fight/flight system. Additionally, complex PTSD involves severe and pervasive problems relating to managing difficult emotions, relationship stress, and negative self-perception.
Is Compassion the Antidote?
In her workshop for health professionals, Dr Lee demonstrated through empirical evidence, reinforced by insightful case studies, and experiential exercises how Compassion Focused Therapy (CFT) has the potential to effectively respond to the debilitating impacts of complex PTSD. As Dr Lee explained, calm minds think differently, and CFT facilitates this process. Unlike a traumatised mind, which maintains a state of fear and shame, a compassionate mind responds to suffering with kindness, courage, warmth, wisdom, and strength. In other words, Dr Lee suggested a compassionate mind perspective recalibrates the brain and body to develop the skills that are linked to resilience and well-being. These are skills that would have been present for survivors of interpersonal trauma had it not been for the experiences they endured through no fault of their own.
Whilst complex PTSD is indeed preventable, Dr Lee’s workshop helped participants develop a sense of hope and encouragement that it is also treatable. If the cause of complex PTSD is characterised by a lack of compassion, the provision and cultivation of compassion may offer the perfect antidote to promote healing.
Dr Lee started her Australian workshop by acknowledging the pivotal moment she attended training facilitated by the founder of Compassion-Focused Therapy, Dr Paul Gilbert, and how it changed the way she understood and worked with clients who had experienced interpersonal trauma. I have no doubt that anyone who attended her Australian workshop and/or keynote address will be recalling their experience in the same way and have been transformed in the way they work, and inspired by her warmth, wisdom, and passion.
 Retrieved from https://icd.who.int/browse11/l-/en#/http://id.who.int/icd/entity/585833559