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The Book
The purpose of the book is to open windows onto the secret lives of adult survivors of attachment trauma in early childhood. Not only traumas of sexual or physical abuse but traumas from the many subtle attachment abuses – both by commission and omission - identified by Briere [1992], described again by Gold [2000] in his book ‘Not Trauma Alone’, and by Lyons Ruth et al, [2006] as quiet. Such abuses often result in subtly hidden traumas unobserved by the child, unnoticed by adult survivors, and misunderstood and misdiagnosed by clinicians [Howell, 2005, 2011].
When exposed to quiet abuse, some children adopt protective strategies based on dissociation. This can produce covert symptoms and developmental arrests that are masked behind a false presenting self which if not checked or treated ‘can grow increasingly elaborate and impregnable with the passage of time’ [Howell, 2011]. In adulthood many such people present for treatment that fails to take into account the elaborately constructed normality of the presenting self [Van der Hart et. al., 2006], and as Winnicott famously said, treat the client as if they existed as real people, when their deepest sense is that they do not [Winnicott, 1976: 151].
The adult consequence of hidden trauma is often not post traumatic flashbacks or multiple personalities, but a sense of hollowness, emotional flatness, and unsettling anxieties and boundary confusions about self and others; together with deficits in mentalising, regression to pre-symbolic forms of affect regulation [van der Kolk, 1987], fragile social interactions and subtle breaks in consciousness that disrupt plans and relationships. Sometimes these symptoms are accompanied by episodes of depersonalisation described by one patient as a “painful, nauseous, place that my consciousness can slide into when so disconnected from my selves it slips through the gaps between them into a black void of nothingness” [2003]. Paradoxically, a quiet sense of there being ‘something wrong’ that needs fixing, together with a hopefulness or refusal to fall into despair often characterises these individuals [Balint, 1968: 19].
I have written this book in the voice of hidden trauma survivors, but I am also aiming it at counsellors who work with adult survivors of hidden childhood trauma, and students who are aiming to do so. The documentation and review of current literature on diagnosis and treatment is designed to provide up to date information on working with survivors of this form of childhood abuse trauma, especially survivors outside the state mental health system managing symptoms that are less florid, more subtle, and often incomprehensible because they cannot be seen and captured in conventional diagnoses. A paradox for these survivors is that they are often so good at fabricating plausible presenting selves, so good at pretending to mentalise [Bateman & Fonagy, 2011], and so sensitive and in touch with the trials and tribulations of others, that they often feel almost supernormal [Krystal, 1994], at the same time as knowing their normality is false.
It is my belief that anxiety, depression and many other common symptoms that clients bring to private sector counsellors, as well as two IAPT services, have their roots in attachment trauma, broadly conceived, and would benefit from approaches recognising the dual liability (Bateman and Fonagy, 2011:427) resulting from attachment trauma, that not only evokes distress but also invisibly compromises many of the capacities, skills and resources essential for a robust sense of self, emotional and relational literacy and all the other subtle background requirements of a ‘good- enough’ everyday life.
It is the adult lives of such children, children with un – associated or ‘false’ selves, whose stories I want to give space to tell. The stories of ‘apparently normal’ people who may have no memories of family trauma or any idea their early lives contained hidden contextual abuse – by omission, criticism or accumulating small insults and un–support of various kinds [Briere, 1992; Gold, 2000] - the results of which are still in visibly affecting their self structure and process and therefore every facet of their lives.
Organised around the lead author's journey backwards in time to the hidden story of his own attachment traumas, forwards in time to the ways he resolved them, and the years in between when lost in a wilderness of unknowing, the book will also include stories of others who in their own way have travelled, or are still travelling on the same road.
By the final stages of my journey – an odyssey of more than forty years – I’d become a clinician, a researcher and a lecturer in counselling education. As such, I hope this book will be educational for prospective students of counselling and psychotherapy, as well as cathartic for me and a resource for others who may be embarked or about to embark on a similar journey into the past and into themselves.
The book has multiple aims, these are some of them
1. to make more public[and acceptable] a hidden condition whose investment in remaining hidden compromises its prospects of treatment
2. to explore what is meant by childhood abuse trauma, in particular what is meant by ‘quiet childhood abuse’ trauma,
3. to suggest that the incidence of ‘quiet’ childhood abuse trauma is far higher than is generally believed,
4. to suggest the consequences of childhood abuse trauma go much deeper and in terms of quality of life are much more dysfunctional than has hitherto been acknowledged,
5. to suggest that the most disruptive and deeply damaging consequences of quiet abuse are its impacts on basic trust, security of attachment and actualizing the developmental potential of subjectivity and intersubjectivity implicated in the transitional space described by Winnicott,
6. to suggest an extension of the dissociation continuum into non-clinical populations, so that symptoms such as depression, anxiety states and other presenting issues of the walking wounded, can be seen not simply as symptoms to be quickly fixed, but potential indicators of an underlying dissociative disorder requiring longer term treatment,
7. to suggest a reframing of dissociation theory to more precisely capture the lived experience of people coping with this sector of the dissociation continuum.
8. to suggest a diagnostic and treatment framework for disorders in this sector of the dissociation continuum, For this purpose I have developed a conceptualisation of dissociation and developmental arrest based on Winnicott and Putnam’s discrete behavioural states theory,
9. to suggest that for the consequences of quiet childhood abuse trauma to be properly and fully addressed, an attachment/trauma/dissociation-based approach to psychotherapy is required
In the current semi-twilight of this complex field, I see my story and my understanding of it providing a small pool of illumination, to which the stories of others treading the same terrain in their own way will help shed further light to help us see the territory more clearly.
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