A Fall, 2018 update:
This was the first piece I wrote publicly. Still, three years later, it has been the most frequently visited page (tied maybe with the Motherwort one). It’s amazing to read it looking back, there are shifts to the way I talk about CPTSD now, about the ways culture sustains traumatization, about the central nervous system and its role in allostasis. I have a more nuanced understanding and critique of mental health language and frameworks. Over these last couple years, my love of allostasis as a framework to work with trauma has gotten more committed. As I moved this writing from its spot on crazyherbalist.co to this site, I left most of it unchanged despite having better language/frameworks for some things now, as the heart of the post, that understanding CPTSD via allostasis can help alleviate how much it feels like a character issue stands true. Thanks for coming by, for visiting this piece and being wonderfully you.
Download a text only .pdf version here.
I have CPTSD.
Well, basically I have that diagnosis, and diagnoses are sort of just a tool to explain in short hand some of the ways we experience life but that's a whole other post...we are more than a sum of our diagnoses, so.....
This post is flavored by my own journey as well as the amazing ones I get to witness with folks whom I serve as an herbalist. And because I can say 'I have CPTSD,' now as opposed to most of my life where it would have been honest to say that CPTSD had me, like had me in its fucking teeth, you may notice a slight irreverence...it's all part of the charm, or tension release....
I have the distinct honor as a plant loving herbalist of getting to work with folks who share big, private and sometimes scary things with me and I wanted to write a post for them, and for others who might have heard of CPTSD or serve folks who have self-identified early and chronic trauma as a part of their life.
Complex Post Traumatic Stress Disorder (CPTSD) is not (yet?) formally recognized in the DSM (the handbook of accepted diagnostic criteria used by mental health professionals and researchers)..it can also be called Complex Trauma or Developmental Trauma Disorder. These diagnoses are attempting to describe a wide and wild set of patterns that clinicians are seeing in folks whose trauma(s) were chronic (think long-term and happening multiple times) and inescapable, as opposed to traumas resulting from a single event or from a series of experiences that can be clearly identified.
CPTSD acknowledges that there are some inherent differences in the way trauma can disrupt a life for folks that don't really have a clear "before the trauma."
Post Traumatic Stress Disorder (PTSD) is a diagnosis developed around and designed to explain the intrusions of anxiety, flashbacks and other pain-in-the-ass repercussions from experiencing an event (or more than one event) that was traumatic and which can typically be identified.
PTSD typically will include the following:
- traumatic experience(s) which can be short or long lasting
- persistent reliving the situation by flashbacks, dreams or circumstances resembling the traumatic event
- actual or desired avoidance of things which are reminders of the trauma (triggers) which was not present prior to the trauma, i.e. the avoidance is a new behavior
- an inability to recall all or some of the trauma might be present
- hyper-arousal which can look like sleep disturbances, anger outbursts, trouble concentrating, hypervigilance, exaggerated startle response, changes in eating and struggle to meet basic needs such as eating
Folks with CPTSD, or if it is called Developmental Trauma Disorder, typically have very similar symptoms as listed above and are often diagnosed initially as PTSD if and when they can point to a single set of circumstances that are traumatic. Often, however, CPTSD folks will get a PTSD diagnosis but not have clear help in redressing some of the underlying differences present in CPTSD. Especially when we are lost in the maze of mental health services.
Essentially what differentiates the diagnoses is that CPTSD includes:
- repeated traumatization, typically during childhood and developmental years, but also over adult years for some
- a real or perceived sense that one cannot escape, totalitarian control, authoritarianism, power over dynamics
- capacity to be fully acquired by emotional and/or narcissistic abuse alone
In CPTSD the repeated traumatization and multiple types of traumas impact the developmental domains:
- attachment and co-regulation <-----huge
- neurobiology & physiology
- emotional regulation and processing
- core identity of self can become fragmented and incoherent
- cognitive and behavioral regulation becomes challenging
- also huge: CAN BE CAUSED BY EMOTIONAL NEGLECT ALONE <--- which often prevents a person from getting help or identifying any trauma in their lives as we have yet to fully explore neglect as commonly as more clearly identifiable traumatic 'events'
Flashbacks often present as "emotional flashbacks" or "somatic flashbacks" without the reliving of a memory through visual or auditory sensation.....these are scary and confusing and less discussed than the flashbacks we usually hear about or see played out on TV
The 'self' literally developed within pervasive trauma/neglect and lack of ability to escape these conditions which makes separating oneself from the trauma freaking hard and complicated and scary. There is no 'before the trauma' for us.
Folks with CPTSD can often exhibit the outwardly signs recognized with PTSD such as anxiety and avoidance behaviors, but we have literally developed our identities within the containers of trauma, neglect, and were unable to make external changes to our environments to bring relief. Because there was an inability to create external changes to protect or remove oneself, the person learns to make deep internal changes, often absorbing as fundamental truths the insidious lies of the traumas in order to survive.
Because of this, relationships can be some of the most challenging and terrifying things to navigate as they are the actual battleground where the original traumas occurred. The ways I learned to understand myself, what I can expect from others and my role in the world was shaped through neglect, gaslighting, manipulation, shame, physical, sexual and psychological boundary violations and isolation. At the core of CPTSD is the very real struggle for trust, especially trusting yourself which includes managing confusing physiological and emotional responses, shifts in the nervous system and heightened distress states even when external environment reads as 'safe.' The primary relationship that is most damaged in ongoing developmental trauma is the relationship we have with ourselves AND it is the one we have to fight the hardest to get back.
With CPTSD and chronic developmental traumas, the stories shaping how we see ourselves are all emerging from seriously fucked-up-ness. There typically isn't a pre-traumatic event place/self to refer to. So we just think we are crazy. And bad. And we operate to a high degree on beliefs and assumptions about safety that we don't even know we have.
we carry a huge psycho-spiritual load.
Let me digress into some exploration about allostasis/allostatic load for a minute, stay with me ☺
Allostasis is a cool ass thing. It is a term used to describe the 'dynamic stability' of our physiology, that is, maintaining a sense of stability through changes in our physiological systems (think digestion, adrenal, hormonal, neurological) as we encounter varying conditions.
Allostasis is the process of meeting changing needs and challenges efficiently, rerouting energy supplies, storing energy for future use, responding to the wide ranges of experiences and regulating the whole system to BE PRESENT. Allostasis is the process of being dynamically in the now: if you suddenly need energy, the body responds; if you have less access to food or nutrients, the body adapts, if you are under a period of high stress, the body shifts its focus to meet those needs.
But there is an implicit dance: high energy demands require the body to mine energy from somewhere. The resulting crash and fatigue or need for greater nutrients is an adaptive response to replenish the mined energy. Conversely, there might be a decreased need for food and sleep for a short period of time to address a period of high intensity. Whatever the exchanges are that are happening in the body, the dance of these exchanges are called allostasis, and it is a dance designed to allow us to effectively respond to things in the present as well as our needs to recover from them.
The name for that total recovery need is allostatic load. This is the cumulative amount of mining we are doing on our bodies' energy reserves. It is the amount of physiological changes and adjustments that have been made to operate on a given set of internal or external conditions. Internal is included here because, yeah, stress and stories that are not rooted in good psycho-spiritual health steal shit from our bodies and spirits. They take. They pilfer. They are every bit as damaging as the cultural expectations that we are supposed to be happy all the time. Productive all the time. Machines. To understand allostasis is to understand that periods high energy demands require periods high of restoration and replenishment. When we neglect or are unable to do the restoration, we eventually can no longer meet the demands.
It is often in this process of meeting the high demands without the sufficient restoration (restitution I think is also a good word here) that a certain rigidity occurs. Somewhere in the process we stop being in the present as we are constantly trying to re-coup. We stop hearing our bodies requests and needs to restore itself. We can't be in a state of needing restoration and continue operating in ways that are not restorative and still be in the present moment. Instead, we keep having the same demands on our energy but develop stories about how we are "too tired," and we "need coffee/exercise/to eat better" or we are "weak/too shy/not good enough/strong enough/something enough." The story becomes one that says there is something inherently bad about us, not the expectations we are trying to live up to, or the adaptations made under decreased capacity for restitution. So we try to address our energetic deficits by making us 'better' in some way. It is when we need one thing but have a story that tells us we should be something else that we leave the present and begin operating off of deficits in physical and psycho-spiritual energies. Like taking out a loan from our life force. One we swear we will pay back.
Modern culture and systemic injustice demands most of us operate this way.
It says we are machines. That there is a superior way to be. That we are built for production and the creation of material capital. It says humans are outside of and destined to rule over nature. It places logic over emotion. Material over experiential. Lightness over darkness. It says there is a primary (better) way of experiencing the world and minimizes divergence. It works in binaries: male and female, good and bad...it suppresses pleasure and prioritizes sex for reproduction or consumption. It tells us we will reach some platitude if we work hard enough and then we can have/deserve restoration to our depleted energy.
It is nearly impossible, without being born into some amount of wealth + socio-political privilege, to escape the effects of capitalism on the body. Capitalism and Patriarchy and White Supremacy are just some of the abusive stories which consistently demand we earn our keep, prove our worth, operate as if we are independently responsible for our success and gas light our cries for a more connected, meaning filled, diverse and restorative way of existing/relating.
The central nervous system, capable of touching all the cells and systems in our body is a primary mediator of these demands.
And usually, something in us, if we are holding ourselves up to the demands of these modern stories, burns out. Our energy production. Our digestive functions. Our immune systems and its coordinated responses with neurotransmitters and inflammatory processes. These are the canaries in the coal mines of our bodies and they are the places we mine our energy reserves from. Non-physiologically supportive stories, personal and cultural, create a very heavy allostatic load. Often we don't even know when we are stuck in the plots of these stories because they are so pervasive and so much a part of what we understand reality to be. (And that is exactly how abuse distorts the reality of someone whose identity was formed under chronic trauma and neglect). As the central nervous system habituates to these stress loads, other peripheral systems get taxed: the HPA axis, endocrine, and immune systems, circulatory systems...these all require efficient communication between each other and coherent narratives about what we are experiencing and what might lay ahead, which breaks down under sustained extraction.
Getting back to CPTSD......
Like I said earlier, we CPTSD folks carry a high degree of psycho-spiritual allostatic load. We totally carry it in our bodies too, and I am going to assume in this post that they are understood to be inseparable. CPTSD in adulthood, after developmental stages have primarily been lived through, is the continued mining of our bodies' life force by fucked up stories (personal and cultural) we learn under traumatic conditions.
- That the world is inherently unsafe (because it totally was/remains to be)
- That people are unsafe (because they were) and isolation is safer
- That shame and self-blame and inherent lack of self-worth are TRUE reflections of our unworthiness (we were shamed for natural feelings and needs)
- That we are inherently BAD. Unavoidably, unfixable BAD (because it was unsafe to see the abusers and neglect as bad during developmental stages so it is internalized and redirected at the self)
- That we cannot trust our self or there is no actual self to trust
- That these realities cannot be changed but instead need to be hidden or conquered through becoming better/more worthy/more likable
Sustained emotional, physical and sexual abuses damage the core connections with self. The stories arising from these violations and neglect can be so ingrained, and so pervasive that we don't even know when they form the basis of our reactions and decisions. Our own emotions/emotional needs are experienced internally as a threat to the whole of the system. We become restricted in our beliefs about ourselves and we get stuck operating in paradigms which we cannot outsmart by working harder to prove our worth, doing everything for everyone because we have to earn affection, avoiding or having conflicting reactions to positive emotions and achievements because they feel foreign and fake and threatening to our nervous system, mistrusting safety because safety isn't really proven to exist.......and when we do have periods of growth, the stories pull us back in through relational flashbacks, self sabotage and self harm.
We stop having a coherent present because it is unsafe and we never feel truly safe. That is our primary story.
Consequentially, the restoration needed to offset the cost of these traumas cannot be obtained. If I cannot trust others and I cannot understand/trust my own emotional needs then I cannot receive the deep restoration and safety which comes from relating: loving and safe friendships, intimate partnerships, community involvement and most fundamentally, deep love and connection with self.
The "healing" of CPTSD, then, involves the rooting out of these stories. Finding them, their origins, their lies, the way they shape our current modes of operating in our bodies and lives.
This requires some form of safety: a safe relationship, survival needs being met and exceeded, time and energy available to do the work. It involves reconnecting to the body, learning to see the self as having inherent worth and listening to the body, discovering somatic experience as safe.
It is pretty common knowledge among mental health practitioners at this point that healing trauma requires a multi-faceted approach, more than just talk therapy, but also things that connect the psyche + soma, bringing together language and non-language oriented parts, the gut, the reproductive centers, the heart......
CPTSD is evolved one new, liberating experience that gets integrated at a time. Sometimes in wild bursts that cause huge changes, and sometimes quietly, when what once would have been a trigger is easily recognized and processed in the present as simply whatever it is. In the process we become less rigid, less beholden to a set of ideals or beliefs that we are operating on unconsciously. We develop a core set of stories that feed us and allow us to detect when we have come into contact with beings and behaviors and feelings that compromise us, that require too high an allostatic load because they deplete more than they restore.
The value in any therapy is the ability to learn to trust and engage with the self safely and in the context of a safe relationship. Connection and new relating also comes in many forms outside of therapy which usually involves discovering some realm in which we are safely able to explore the self and make new stories. (Ahem, nature............ ☺)
EVERYTIME WE UNCOVER ONE OF THESE STORIES OR MEMORIES, PROCESS THE EMOTIONAL IMPACTS, DE-THRONE THE STORY FROM BEING INHERENTLY TRUE AND REPLACE IT WITH A TRUTH THAT EMERGES FROM OUR CORE, WE REDUCE OUR PSYCHO-SPIRITUAL ALLOSTATIC LOAD. WE FREE UP ENERGY FOR RESTORATION.
And suddenly, at some moment in the process, you might learn to give no fucks.
Things that once were beholden over you and great sources of psycho-spiritual pain become things you no longer care to offer any of your precious life force to. Sometimes the pendulum swings a bit wide into give no fucks territory when that power is first unleashed. Sorry about that. It is a learning curve we are making up for after an entire period of life where we gave so many unbalanced cares about all the terrifying things that could possibly reinforce the internal terror of believing you are so inherently bad or ugly or worthless or stayed in abusive relationships or avoided intimacy all together......the pendulum will swing back into moderation.
And when it does, the deep pleasure of finding some, often small, internal freedoms from these tyrannical old stories is so rich and so restorative that giving no fucks to anything that even hints of codependency, abuse, emotional vampirism, self harm and cultural oppression of self and others takes on a momentum; it becomes our new story. It becomes natural for the first time to start moving past psycho-spiritual and physical survival-mode and embrace the dance of life, of giving and receiving. We move closer to restorative frameworks of relating, prioritizing restoration and health.
It's a long ass process. Life long. Cyclical, non-linear. It is some of the hardest work I have ever done, learning to trust me. ME. To be in the present with myself and discover that there is inherent worth and that I am capable of taking care of me. And it is so damn worth it. Even on the days I howl angrily that it is something I have to do.
Living in the purgatory of old stories metamorphosizes like plants pushing through the cracks along sidewalks and within walls, not be beholden to a city's oppressive desire for plant-free walkways. Nor will we be forever bound to caregivers' abuses, traumatic events and cultural stories which seek to extract from us. There is fertile soil under that rigid cement. There is so much energy to be freed for the dance of our lives, whether you are healing from trauma or saying you will no longer be the subject in the modern industrial story that you are a machine separate from nature and that your adrenals will output forever.
We are still situated in the present cultural demands/oppression, which already extracts in differing levels depending on our places of privilege. There's no 'boot-strapping' it away. Our ability to push back and find private restoration increases dramatically when we have tools and resources to explore our trauma/CPTSD, dismantling incorrect stories, restoring our relationship with self and returning to the dance of the present: allostasis. ☺
The reduction of any form of allostatic load frees up energy to both seek restoration and address other causes of high allostatic load. So when we are able to sleep/eat/digest/process things better physiologically, we have more energy to address things psycho-spiritually and vice versa. Plants really can help us reduce the effects of high allostatic loads. Internal use of plants can often help shift tissue states and emotional states which have inflamed or stagnated or become rigid... When I work with someone I am often collaborating less on their symptoms and more on their restorative capacities, the reduction of allostatic load that can come from well matched plants with individual needs. Nature is restorative and relational.
Sitting with a plant, listening, admiring and talking to to it is one of the most understated forms of herbal medicine. Plants can help us fall in love, into genuine places of connection with other living (non-human) beings....sometimes when we find that one that moves us so much we remember we are alive and that connection can feel really good and is worth fighting for. They can be a gateway for us to explore relating as a skill. Finding plants that can help us shift our internal states restores some feelings of control and power over our experiences, a feeling that is often taken away when we experience anxiety/dissociation/flashbacks, etc...and, it returns that power and sense of autonomy in a way that feels less isolating. Aromatic plants, when sniffed or burned help cleanse and shift space so that we can loosen our energetic state of being when it is feeling rigid or dominating. Plants teach us and communicate through non-language based means and therefore help us connect to and be with those more somatic and tacit parts of ourselves. Plants can be fun and fun as a state is incredibly important, yet often terrifying for many of us with CPTSD.
So, dear ones, plants. CPTSD. Allostatic Load. You. Me. Kicking Ass. Changing tired, old ass stories and replacing them with restorative, deeper truths rooted in nature and empowerment.
I fully recommend periodically assessing your allostatic load. We can get curious at any point about:
- How much restorative sleep am I getting?
- How are my energy levels?
- Am I getting enough calories? Am I digesting? Pooping well?
- Have I had restorative interactions (restorative defined as not draining, but fulfilling) with my primary relationships, including myself?
- Notice on the last question I said including myself? Yeah, how am I feeling about myself right now?
- What systemic injustices am I navigating?
- How is my anxiety level?
- Any depression, freezing, dissociation?
- What support, if I could have anything I wanted, would I call in?
- How much have I laughed, played, had pleasurable experiences recently?
Assess if your demands are equaling your restoration and if not, be kind to yourself. Letting this awareness sink in can help us be compassionate towards the inner-critic driven narrative that we aren’t supposed to be needing anything or that there is some magical us that can find the perfect formula to outwit the weights of these extractions.
Trauma sucks. CPTSD sucks. But we don’t. We ride those allostatic waves in our courageousness.
I'm so, so grateful for everyone who commented on the original post! To honor your words and kindnesses, here are the original comments uploaded as a gallery of images.