Addiction to Trauma and the Piranha Theory

Victims who return to their abuser or who do not leave a dangerous situation are often referred to as being “addicted to their abuser” or “addicted to trauma.”  The concern with using this statement is that given the stigma connected with addiction to substances this description of a survivor of abuse can appear to be victim blaming.  The victim is seen as seeking out the abuse as a means of feeding some sort of need rather than placing the blame on the perpetrator or perpetrators who have significantly impacted the brain chemistry of the victim in a way that resembles the addiction process.

According to Bessel van der Kolk quoted in Sandra Bloom’s article Trauma Theory Abbreviated, ”one hypothesis is that people can become ‘addicted”’ to their own internal endorphins and as a result only feel calm when they are under stress while feeling fearful, irritable and hyperaroused when the stress is relieved, much like someone who is withdrawing from heroin.  This has been called ‘addiction to trauma.’”

The important distinction to make is that this “addiction” is a physiological response caused by the actions of another individual as a means of power and control.  The victim does not seek out the pain.  Instead the victim is seeking relief from the tension that builds when an atmosphere is calm.  In fact, it may be important to recognize that calm and safe surroundings can feel threatening to a trauma survivor and this creates a greater risk of returning to the abuser.

Although the addiction hypothesis explains the physiological origins of the behavior, it may also be helpful to look at what is happening emotionally and psychologically.  Admittedly, this is becoming harder to differentiate as we learn more about the brain, but it can be helpful to our understanding of victim/survivors.

The Piranha Theory - When a person grows up in an environment that is dangerous physically and/or emotionally, it results in the physiological responses noted above.  In addition, skills are learned in order to cope with the environment.  These may include the physiological response of dissociation and other responses such as lying, manipulation, running away, withdrawal and isolation, or over achieving and enhanced competence.  In other words, when a person grows up in fish bowl of piranhas a great number of responses are developed in order to stay safe in that environment.

Now imagine that a person with the skills to manage piranhas is moved to safety.  Rather than feeling safe, the person is going to be looking for the hidden piranhas.  She/he does not believe that there are no piranhas so she may feel ambivalent about giving up the behaviors that controlled the environment in the past.  The survivor may be looking for danger at every corner because that is what she is used to.  This is causing and is caused by a physiological response that is a reaction to perceived danger, real and imagined, and experienced previously. 

Being trauma responsive in our work with survivors includes providing safety and stabilization in addition to refraining from actions that could re-victimize the person.   Physiological stability cannot be achieved as long as the person is on an emotional roller coaster of stimulus and response (Bloom, 1999).   Once a person feels stable physiologically, she can then start the work of changing behaviors that correspond to the new environment.  This takes work and giving up old behaviors when there is constant fear and worry that the perpetrator is still around the corner.  Our acknowledgment of this struggle and assistance with stabilization is infinitely more productive than labeling a person with an “addiction to trauma.”

Looking at Learned Helplessness through a Trauma Lens

Over the past forty years there have been a number of theories about why a woman stays in an abusive relationship.  In some cases, these can be reduced to victim blaming, putting the total responsibility for the abuse on the victim.  Even explanations that make sense can end up being used in a way that demean, blame, or place the victim in a passive role that seems to be of her own making.  One of these is Lenore Walkers’ theory of “learned helplessness.” In the 1970's, before we were able to learn about the effects of trauma on the brain and body,  Lenore Walker, a psychologist in the United States, studied the behavior of women who stay in violent relationships, and hypothesized that women stay in abusive relationships because constant abuse strips them of the will to leave.  This theory, while helpful in helping some juries understand why a woman may not leave a relationship, does not take into account that there are many social, economic and cultural reasons a woman may stay.  Learned helplessness has also over the years become a term that pathologizes victims’ responses to violence, leaving some to believe that there is something wrong with the victim versus placing the blame on the abuser. 

As Dobash and Dobash explain, “[w]omen are usually persistent and often tenacious in their attempts to seek help, but pursue such help through channels that prove to be most useful and reject those that have been found to be unhelpful or condemning.” Battered women do not live their lives in a state of “learned helplessness.” On the contrary, they often engage in a process of “staying, leaving and returning.” During this process,

women make active and conscious decisions based on their changing circumstances: they leave for short periods in order to escape the violence and to emphasize their disaffection in the hope that this will stop the violence. In the beginning, they are generally not attempting to end the relationship, but are negotiating to reestablish the relationship on a non-violent basis. From R. Emerson Dobash & Russel P. Dobash, Women, Violence and Social Change 222-23, 225, 229-32 (1992).

Learned helplessness theory was based on perceived characteristics shared by battered women, such as low self esteem, a tendency to withdraw, or perceptions of loss of control. Those who espoused the theory, however, rarely took into account the fact that these characteristics” might be, in fact, the physiological effects of the abuse on the brain of the survivors. 

In the article Trauma Theory Abbreviated, Sandra Bloom quotes behaviorist Martin Seligman’s research on learned helplessness in animals to describe the physiological changes in the brain.  “Apparently, there are detrimental changes in the basic neurochemistry that allows the animal to self-motivate out of dangerous situation.  Change only occurs when the experimenter actively intervenes and pulls the animal out of the cage.  At first, the animal runs back in, but after sufficient trials, it finally catches on and learns how to escape from the terror once again.  The animals’ behavior improves significantly, but they remain vulnerable to the stress.  As in human experience, animals show individual variation in their responses.  Some animals are very resistant to developing ‘learned helplessness’ and others are very vulnerable.”  

To understand what happens after a traumatic event we must begin with the “fight-or-flight” response that characterizes the way human beings and other mammals respond to overwhelming stress. The ability of the brain to process information in this state changes dramatically from its normal state, just as the body’s response is remarkable and dramatic. The brain is profoundly affected by the powerful neurochemicals that flood the body as a part of the normal stress response. In this state, the ability to encode experience in words often becomes compromised and instead, stress is experienced as strong emotional reactions, body sensations, and images. In such a state, the person is geared toward action, not thought and in fact, there is a decreased ability to think clearly. http://www.sanctuaryweb.com/psychobiology.php

Looking at the neurobiology of the trauma may also lead to pathologizing a person’s responses but there is one clear factor that must be taken into account – the presence of an abuser who created the environment, maintains the power, and benefits from the helplessness of the victim.   The realization of this returns us to the main premise of being trauma responsive – “it is not that there is something wrong with the victim, it is that something was done to her/him” that has caused that behaviors or adaptations that we, as advocates, may see impeding a person’s process of change.  Our own responses can, at times, perpetuate feelings of helplessness in survivors.  Lack of housing, daycare, and other supportive services can also lead to feelings of helplessness.  According to Dr. Bloom, “we know that people can learn to be helpless too, that if a person is subjected to a sufficient number of experiences teaching him or her that nothing they do will effect the outcome, people give up trying.  This means that interventions designed to help people overcome traumatizing experiences must focus on mastery and empowerment while avoiding further experiences of helplessness.”

Reference:http://www1.umn.edu/humanrts/svaw/domestic/link/healtheffects.htm

BOOK REVIEW Creating Sanctuary - Toward the Evolution of Sane Societies by Sandra Bloom

Creating Sanctuary  - Toward the Evolution of Sane Societies  by Sandra Bloom  1997, Routledge Publishing

Creating Sanctuary is an excellent book to have on the shelf at any program providing support to victims of complex trauma.  Sandra Bloom’s book is over ten years old but I found it to be a refreshing look at trauma and how organizations can build and sustain a sanctuary for victims. 

According to her biography on the Drexel University website, Dr. Sandra L. Bloom is a Board-Certified psychiatrist, graduate of Temple University School of Medicine and recently was awarded the Temple University School of Medicine Alumni Achievement Award. In addition to her faculty position at the School of Public Health at Drexel, she is President of CommunityWorks, an organizational consulting firm committed to the development of nonviolent environments. Dr. Bloom currently serves as Distinguished Fellow of the Andrus Children’s Center in Yonkers, NY.
From 1980-2001, Dr. Bloom served as Founder and Executive Director of the Sanctuary programs (see link at left), inpatient psychiatric programs for the treatment of trauma-related emotional disorders. n partnership with Andrus Children’s Center, Dr. Bloom has established a training institute, the Sanctuary Leadership Development Institute, to train a wide variety of programs in the Sanctuary Model®. The Sanctuary Model® is now being applied in residential treatment programs for children, domestic violence shelters, group homes, homeless shelters and is being used in other settings as a method of organizational development.
Dr. Bloom is a Past-President of the International Society for Traumatic Stress Studies and in addition to being the author of Creating Sanctuary: Toward the Evolution of Sane Societies and she is co-author of Bearing Witness: Violence and Collective Responsibility.

This highly readable book is broken down into five sections.  Section one is a comprehensive view of trauma theory that reviews the research done by a number of experts in the field of trauma and neuroscience.  She includes the physical, cognitive, emotional, social, and behavioral responses and discusses the innate need for the survivor to make meaning out of the trauma that has occurred.  By telling the stories of trauma survivors, Dr. Bloom demonstrates how a victim’s life can become completely organized around trauma in their thoughts, feelings, behavior and meaning making.  Section Two responds to the question “if traumatic experience is so damaging, and human history has been so traumatic, how have we survived and thrived?” by explaining how our attachments to each other and our social groups that follow us from cradle to grave help survivors heal from trauma.  Section Three discusses the social in psychiatry and how some treatment milieus and concepts have not served trauma survivors well.  Dr. Bloom speaks to the impact that feminist theory has had on psychiatry and how it facilitated a shift to a more relational and empowerment based model of meeting the needs of trauma survivors.

In sections four and five, Dr. Bloom takes the reader beyond the usual scope of trauma as an interpersonal issue that is healed within one to one relationships and encourages us to examine reconstruction society as a whole within a sanctuary model.  She lists shared assumptions that encourage the reader to look beyond diagnosing and treating to engaging in the creation of healing sanctuaries.  This includes assessing burnout, vicarious trauma, and practices within the organization that may limit the abilities of advocates and others in providing support.  

The last section, “Toward the Evolution of Sane Societies”, documents the significant trauma that occurs within society as a whole and addresses how the world at large contributes to trauma.  This book was written well before September 11, 2001 and it would be interesting to have an update in regards to Dr. Bloom sees the terrorism and the responses of our government as contributing to the traumatization of individuals and societies. According to Dr. Bloom, the globalization of trauma and the effects on individuals needs to be addressed beyond the scope of individual organizations.  It requires social changes, changes in the way we do business, changes in the classroom, recognizing justice as a force for healing trauma, creating an emotionally literate population, and being willing to bear witness and move beyond just being a bystander.

The depth of this book in addressing the issue of trauma can at times be overwhelming and challenging.  However, Dr. Bloom does an excellent job of outlining the issues surrounding traumatized societies and addressing it by creating a model for sanctuary in our organizations, social service agencies, and political institutions.

This book is being added to the NHCADSV library and is also available on Amazon.com or through your local bookseller.