I've given up on the series of CPTSD book reports I planned. I spent too much time wanting to throw the books at the wall. Which is a problem, because most of them are e-books, and I'm pretty attached to my Kindle. Plus the noise would scare the rats.
Almost all of the available books on the subject are formatted as self-help texts, and fall afoul of the same thing all self-help materials do. They're written for the lowest common denominator. They don't necessarily assume the audience is stupid, but they do assume the audience is starting from a place of complete ignorance. This is great if you are indeed starting from scratch, but irritating as fuck if you've already gotten past the 400-level research class and really just need to know how the last guy to run this lab kept the still from exploding all over the inside of the fume hood.
The books also spend a lot of time holding your hand. They talk in circles and spew a lot of words reassuring the reader that they are worthwhile people and they can take action to fix their own lives. I understand why this is considered a feature, not a bug, but good gravy, you have to wade through so goddamn much of it to get to the actual information.
The one exception to this is The Body Keeps The Score, by Bessel van der Kolk. It's reputed to be a difficult but useful read among CPTSD patients. Van der Kolk was writing for an audience of clinicians, not sufferers, so he does not tiptoe around some of the nastier parts of his patients' backgrounds. I'm not set off by case histories or descriptions of psych symptoms, but if these do trigger you, then you have been warned. He does get a little TMI in general. I did appreciate that he treated his patients more like 'people who have some problems in common', rather than Pete Walker's 'boxes into which everyone fits, even if you have to jam them in sideways'.
Unfortunately, the best thing I got out of van der Kolk wasn't new information, just some confirmation of things I already know to be true:
- CBT/DBT doesn't help a whole lot
- Sometimes drugs do!
You can read up on cognitive behavioral therapy (CBT) or dialectical behavior therapy (DBT) in about a million places, but the basic idea is that your thoughts, actions, and feelings all affect each other. If you feel like your life is horrible, it's probably because you keep shooting yourself in the foot. If you keep shooting yourself in the foot, it's probably because you have somehow got the idea that you're supposed to shoot yourself in the foot. If you fix your screwy thinking, then you'll choose better actions, such as not shooting yourself in the foot, which will ultimately result in you feeling better.
I am not saying that this is untrue. It works in the sense that doing fewer stupid things results in fewer stupid situations in which one might reasonably feel terrible about what's going on. It helped me a lot in college when I was trying to figure out why I ended up crying hysterically every time I talked to my mother. The worksheets are very concrete and they're a very good stopgap for working out what to do in situations where you need to take (or not take) some action in the short term, but you're too panicked to think.
However.
The thing about trauma reactions is that they're not habits. They're hard-wired. Particularly in CPTSD -- the C is for "complex", indicating that the inciting incident wasn't one-and-done, but being stuck in a chronically shitty situation over a long period of time. All those weird knee-jerk reactions that are so dysfunctional in real life were necessary for your safety in said shitty situation, so they got ground in good. They hit way before any conscious thought is involved. You do wind up with some pretty screwball thinking, but it's not the cause; it happens later, when you're desperately trying to come up with some rational reason for whatever you're feeling, because if you know why it happens then maybe you can figure out how to stop it.
So what happens when you try to apply CBT to this is that it solves the immediate problem of "how do I not shoot myself in the foot?" The first thing you do in one of those worksheets is interrogate that knee-jerk reaction with extreme prejudice -- a basic assumption of CBT is that while your feelings are not necessarily wrong, they are also not necessarily right, or even really connected to what's going on, so they are best regarded with deep suspicion. And if you're having one of those knee-jerk trauma reactions, tossing out whatever overwhelming emotion has smacked you in the face and basing your actions on the facts is the best way to keep yourself out of practical trouble.
But since it isn't fixing the root cause of your panic/anger/hysteria/whatever, you just go through the same process every. single. time. Word for word, after a while. And since you're technically functioning better on the outside, no matter what you're going through on the inside, you get a lot of feedback from other people indicating that you're less of a pain in the ass to be around. It becomes apparent that the only way to be accepted in society is to spend every ounce of energy pretending to be someone who is way more functional than you actually are.
This is not great. Specifically, this is the same way a lot of people ended up with CPTSD in the first place: Being stuck in an environment where the only way to be acknowledged and survive was to pretend you were totally fine at all times and had no needs. Although I suppose it does inadvertently serve as some really good acting lessons, so there's that.
The way you actually train yourself out of the trauma reactions is to just be around people who are consistently not horrible over a long period of time, and to have enough moments of clarity to realize that. Which is where the drugs come in.
The drugs in question are not things like antidepressants, which do help many people, but don't do much in the immediate term to stop a freak-out. Short-acting anxiolytics like diazepines have been useful for me, but they don't like giving you those unless you strike them as the sort of person who won't actually take them. More interesting are drugs that cause a flood of serotonin, like MDMA, psilocybin, or LSD, or those that act as acute dissociatives, like ketamine. It has been noted, in the occasional scientific study and/or eighty bazillion trip reports on Erowid, that these substances can neurochemically halt the cascade of panic while not necessarily removing your ability to think in complete sentences, like the GABAergic knockout drops do.
This tends to widen what therapists call the "window of tolerance" -- basically, how deep can you dig into the upsetting stuff before you're too emotionally distressed to hang onto your train of thought. Serotonergic things are bad for me, because Reasons, but the dissociative family has been useful ever since I discovered DXM made me temporarily stop caring about panic attacks. Apparently other people use this phenomenon for therapy with actual therapists; I just block off an evening for lying on the bed, listening to music and sorting things out. My adrenal glands can do whatever, it's not important, I've got stuff to think through.
I have never figured out what other people get out of therapy that I don't get from drugs and talking incessantly to a box of rats. I assume they get something or they wouldn't go. I've never thought it was a great idea to share any of this stuff with anyone who wouldn't share in return, which no ethical therapist ever would. I do appreciate an actual clinician with actual experience treating CPTSD confirming a bunch of stuff I've already figured out for myself. On the other hand, he doesn't seem to have anything to offer that I haven't already tried, which suggests that I'm really never going to get any better help than "drugs and an uninterrupted evening". I don't quite know how to feel about that, other than moderately disgruntled that I once again have to do everything my goddamn self.
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