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PTSD is the Compartmentalization of Terror: from Children to Veterans

As a trauma therapist, I hear a great deal of painful stories with what many would deem horrific scenes. I’m not gauging a story told by a client by its plot line and adjectives, I’m gauging it by its emotional circuitry. The plot line for me is in the sequential energy of the experience and where that electrical sequence got thwarted, frayed, entangled. My career started with working with children and adolescents, and, of course, their parents. When a child has lived through a traumatic experience, you can no doubt bet the parent did in their childhood as well. Trauma is generational backward and forward. My goal is to halt the forward movement and let the healing collapse backward, as I say to clients ‘like a wormhole.’ And I believe that to be true.

What I learned in working with children, and from my own childhood, is that our psyche is beautifully protective and has a very specific way of doing this. It's the art of compartmentalization, and it is a uniquely created masterpiece I get to gaze upon as a therapist. The art gallery of the human psyche is infinite in its carefully orchestrated metaphors and intricate subtleties in layout. I believe compartmentalization is a natural process, not born of trauma, but simply the effect of being an expansive human caught in a world of roles and structure. Trauma simply makes it more defined. If a child has watched a violent scene at home the night before, they go to school the next day and play the role of a student. They often will also play the role of a kid who simply wants to play, which is the very nature of all children, and of all adults, but closer to the surface in a child. Sometimes children can do that very successfully, with no outward signs of what may be happening in their private life. Sometimes, the emotions from the trauma burst through unexpectedly with sharp edges that show up and get redirected. And sometimes, when the trauma is too much to hold down, it becomes a personality trait, or what others deem a personality trait, either out of denial or ignorance. In my case, I was deemed shy. It was selective mutism. No 5 year old has the words to express the emotional circuitry of what I had been witnessing. Eventually, selective mutism turned into what's labeled social anxiety, though I learned to develop some close friends in those early years, and I had four brothers and many cousins where play could still be an option. I was smart, and school came easy for me, so I could also comfortably slip into a student role. I learned how to compartmentalize the trauma, allow my play and imagination parts to stay present, and maintain the role of the ‘A’ student. I entered therapy in my 20s and began opening up the compartments. This is what I know brings all my clients into therapy, at whatever age they are upon arrival, the hope of opening up the compartments.

The action of compartmentalization in the human psyche is the same process and the same desired outcome in adults as it is in children. It is protective; it is self-preservation; it is a survival tactic. The military does a wonderful job at conditioning high-level compartmentalization through the process of boot camp, repetitive reinforcement in language, and learning to manage action through drills that create a schemata for muscle memory. It is necessary for war. However, that high-level conditioning of compartmentalization is ripe for PTSD, especially since most of those compartments created have no space in the civilian world. There is no daily activity that mimics boot camp, or requires that well-developed muscle memory. Instead, all the emotional circuitry that was tended to with that conditioning while at war now has to be re-conditioned in order to tend it in the normal day to day. When working with veterans and beginning to open those compartments, the emotional circuitry is no different in this weathered soldier than it is a bright-eyed child. What I find always lies in those compartments is terror. When I see PTSD sitting in front of me in my office, whether acute, chronic, complex, I know we will be venturing into terror at some point. There is no emotional circuitry that is more avoided because, by its very nature, terror is the threat to our survival, and PTSD is the Master of avoidance. Why wouldn’t an internal system that is dedicated to our survival compartmentalize our experiences of terror so that it could remind us to keep living? I find it beautiful that our desire to live, to love, find joy, keeps rerouting anything that might take that away from us. Even though its efforts go awry, it is still an effort toward happiness, and that tells me everything I need to know about a client. I know I have a human in front of me fighting the good fight.

A Veteran client asked me once, ‘How are you? How are you doing hearing all of this? How do you listen to people dump their problems on you all day?’ It makes sense for someone to project that I would be in discomfort sitting on the other side when so many feelings are still uncomfortable for them. As a trauma therapist, and I feel like I can speak on behalf of my colleagues in this field, you do not do trauma work without having done your own trauma work. The scenes may change, but that emotional circuitry that is the background soundtrack of that scene for which we are truly working with, has a familiar frequency in it, regardless of the artist, and that is terror. Terror that we will not survive. For an adult, that terror may be a war zone, an assault, a car accident, a medical diagnosis, or any loss so great it feels like failure, shame, or abandonment. For a child, that terror can also be a war zone, violence in the home in whatever form that may take, a natural disaster, loss of caregiver. It can also be neglect, dismissal, apathy, exploitation, or emotional abandonment from an overworked, or depressed, or substance-dependent parent. A child's brain may not know how to define survival, but it understands the threat on a visceral level. Their needs for survival are immense and the threat is heavily weighted, because they have no power.

PTSD, and trauma in all its forms, is written in the key of terror. There are variations in the composition; there are variations of the genre; there are variations in the rhythm. But that key is always present somewhere in the narrative. As trauma therapists, we help clients integrate that part of their story as an interlude, a crescendo, that can be slowed down, smoothed out; and then, dissected so that all the notes that joined into that climactic moment of their life can be used in the tune of their everyday without sending them back to crescendo.

Many think there is no way to incorporate past terror into your life and feel whole, but that is not true. As good as the psyche is at compartmentalizing, it is even better at integration. Both are a masterpiece, one feels much better than the other.


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