Martha Stout, Ph.D. Book Excerpts

From the "Signs of the Times"

The Myth of Sanity
Martha Stout, Ph.D. Book Excerpts

Recently we have quoted from Martha Stout's book The Sociopath Next Door. This book should be required reading for every normal human being. We also reccommend Predators: Pedophiles, rapists, and other sex offenders by Anna C. Salter Ph.D., for everyone, particularly women and parents. What you don't know CAN hurt you and most particularly, your children. Save a life TODAY: Knowledge Protects!

Today, we would also like to bring to the attention of our readers another book by Dr. Stout. It is entitled The Myth of Sanity. The Myth of Sanity is about survivors of trauma including being traumatized by psychopaths or other pathological elements of our reality. Below are excerpts that we believe will serve as an introduction to further reading and research and even work on the self, with or without therapeutic intervention. It seems that the survivors of trauma have a lot to teach the rest of us about LIVING.

My patients come from both genders and all walks of life. Some are simple. Others possess intellects as brilliant and faceted as diamonds. Most are somewhere in between. They come to my office bearing a wide variety of diagnoses currently in medical vogue: depression, manic-depressive disorder, panic disorder, anorexia nervosa, alcoholism, borderline personality disorder, paranoia. Their stories are seemingly diverse. Some have survived earthquakes. One, when she was two years old, watched from inside the basket someone had hidden her in, as her Cambodian parents and nine sisters and brothers were shot to death by invading soldiers. Many others have survived chronic childhood incest. Still others are adult survivors of other kinds of childhood-long abuse, physical and psychological.

I have learned that they all have one thing in common. Underlying the various forms of heartrending pain and diverse complaints with which they come to therapy is the same fundamental question: shall I choose to die, or shall I choose to live? They come to therapy to help themselves answer that question...

The survivors I see in my practice have known undistilled fear, have seen how nakedly terrifying life can be, and in many cases have seen how starkly ugly their fellow human beings can be. ... In a struggle with the power of their past experiences, even the biological imperative to survive is puny.

...What is so extraordinary about these people is that they choose to live - not just to "not die", not just to survive, but to LIVE.

I have become convinced that these courageous people, in winning their struggles, must learn things about genuine living, and about genuine sanity, that the rest of us have never even imagined.

The honest, purposeful self-examination of a traumatized life creates a heat so exquisite that it burns away the usual appeasements, self-deceptions, and defenses. "What is the meaning of this life?" becomes a very personal question and demands an answer. Some of the people I have known have burned so fiercely that they have gone all-stop, have quit their jobs, and even endured temporary poverty, because answering the question consumed more energy than can reasonably be generated by a solitary individual. There is something electric in the eyes, a little wild.

But paradoxically - and yet, I think, for all the same reasons - these same people often reveal an irresistible sense of humor, an ironic angle on life that has dispensed with the polite and the guarded, and that tends to get right to the core of things. And so, though it may sound odd, when I am with my patients, I laugh out loud a lot.

Many trauma patients are detached and objective when they speak of extraordinary events... As I listen to the telling of a personal history, more often than overt "symptoms," it is just such Faulkneresque understatement of the sometimes macabre, along with the burning light in the eyes, and the cunning humor, that makes me begin to suspect extreme trauma in the individual's history.

I am impressed with the irony that these severely traumatized patients, people who have been through living nightmares, people who might blamelessly choose death, often emerge from successful treatment by constructing lives for themselves that are freer than most ordinary lives from what Freud, a century ago, labeled as "everyday misery." They become true keepers of the faith and are the most passionately alive people I know.

Or maybe it is more necessity than irony. I have been told more than once by the survivors of trauma that it would not be worth the struggle merely to go on surviving. And that is exactly what most of the rest of us do: we do not choose to die, or to live; we go on surviving. We do not choose nonexistence; nor do we choose complete awareness. We slog on, in a kind of foggy cognitive middle-land we call sane, a place where we almost never acknowledge the haze.

Over the years, what my trauma patients have taught me is that this compromise with reality and its traumas is simply not sanity at all. It is a form of madness, and it befuddles our existence. We lose parts of our thoughts in the present, we sabotage the closeness and comfort in our relationships and we misplace important pieces of ourselves.

All of us are exposed to some amount of psychological trauma at some point in our lives, and yet most of us are unaware of the misty spaces in our brains left there by traumatic experience, since for the most part we experience them only indirectly. Seldom do we ponder the traumatic events in our own lives, let alone the frightening hardships and life-or-death struggles that were the daily lot of people as close to us, in terms of time, as our great-grandmothers or even our grandmothers.

But we do feel crazy, and a little silly, when from time to time we cannot remember a simple thing we ought to be able to remember.... And we feel our insanity and sometimes a near-frantic sense of being out of control of our lives, in the misunderstandings and rifts in our most cherished relationships, in the same emotionally muddled arguments that go on for years and years. The conflicts never quite kill the love that we feel, but they never quite end either. And, as a society, we feel incompetent, and sinkingly helpless, when we reflect upon the greater-than-half failure rate of marriages in general.

Too many of us walk on eggshells around our life partners, theoretically the very people whom we should know the best. We do this because we are never certain when that lover or that spouse is going to become aggrieved, or fall silent, or fly into an impenetrable rage at something that happens, or at something we have said, and becomes a distant stranger, a different person altogether whom, in all honesty, we do not know at all.

[We make resolutions to do things] but when we actually try to think about accomplishing our resolutions, our thoughts skitter away from us like frightened deer from an open meadow, and in the next moment our minds are elsewhere - anywhere else- the rising price of gasoline, a memo at work, a spot on the carpet.

Many of use find it difficult, and sometimes impossible, to stay in one "mode," to be constant and recognizable, even to ourselves.

One of the most universal examples of this is the experience of returning "home" to one's parents. After a family visit, the commonest revelation, sometimes private and sometimes voiced aloud to friends, is "I turn into a different person. I can't help it. I just do. All of a sudden I'm [a kid] again."

We are completely grown up, may even consider ourselves to be rather sophisticated. We understand how we ought to act, know what we want to say to our mothers and our fathers. We have plans. But when we get there, we cannot follow through - because suddenly, WE ARE NOT REALLY THERE. Needy, out of control children have taken over our bodies and are acting in our stead. And we are helpless to get our "real" selves back until well after we have departed from our "homes."

Perhaps worst of all, as time passes, we often feel that we are growing benumbed, that we have lost something - some element of vitality that used to be there. Without talking about this very much with one another, we grow nostalgic for our own selves. We try to remember the exuberance, and even the joy, we used to feel in things. And we cannot.

Mysteriously, and before we realize what is happening, our lives are transfigured from places of imagination and hope into "to-do" lists, in to day after day of just getting through it. Often we are able to envision only a long road of exhausting hurdles that leads to somewhere we are no longer at all certain we even want to go.

Instead of having dreams, we merely protect ourselves. We expend our brief and precious life force in the practice of damage control.

And all because of traumatic events that occurred in the long ago past, that ENDED in the long-ago past, and that, in actuality, threaten us with no present danger whatsoever.

How does this happen? How do childhood and adolescent terrors that should have been over years ago manage to live on and make us crazy, and alienated from ourselves, in the present?

The answer, paradoxically, lies in a perfectly NORMAL function of the mind known as dissociation, which is the universal human reaction to extreme fear or pain.

In traumatic situations, dissociation mercifully allows us to disconnect emotional content from our conscious awareness. Disconnected from our feelings in this way, we stand a better chance of surviving the ordeal, or doing what we have to do, of getting through a critical moment in which our emotions would only be in the way.

Dissociation causes a person to view an ongoing traumatic event almost as if she/he were a spectator, and this separation of emotion from thought and action, the spectator's perspective, may well prevent him/her from being utterly overwhelmed on the spot.

A moderate dissociative reaction - after a car crash, for example - is typically expressed as, "I felt as if I were just watching myself go through it. I wasn't even scared."

Dissociation during trauma is extremely adaptive; it is a survival function.

The problem comes later: long after the ordeal is over, the tendency to be disconnected from ourselves may remain.

Our old terrors train us to be dissociative, to feel safe by taking little psychological vacations from reality when it is too frightening or painful. But later, these mental vacations may come upon us even when we do not need them or want them, or recognize them. Being "trained" by early trauma to dissociate, being "habituated," we depart from ourselves. Those we love also depart from themselves, and these unrecognized psychological absences play havoc with our lives.

Not surprisingly, survivors of extreme psychological trauma have extreme dissociative reactions.

Listening to my trauma patients has allowed me to understand not only dissociation itself, but also how to overcome it. I have come to believe in the possibility, for all of us, of staying in touch with reality, of becoming truly SANE. If trauma survivors can learn to remain present with the reality of their memories, if they can make a commitment to live their lives consciously and meaningfully, so can people who have not suffered such extreme trauma.

The mental reality - [how they have been programmed to perceive the world] - of the extreme trauma survivor is full of violence and violation, natural demons and unnatural acts. I wonder every day how such people find the courage to decide to go on living. Such individuals live in a world where trusting someone is NOT an option. What's more, one's own imagination becomes and inescapable stalker. In such a landscape, whenever the inhabitant becomes so bone-weary that she/he lets down his/her guard a little, another memory cabinet door swings open to reveal precisely the thing that she/he cannot endure. This "thing" is different for each person, but it always hovers at the outside limit of terror.

Letting down his/her guard is at once what the trauma survivor most achingly desires and what he/she most vigilantly avoids. It is a universe of fear and exhaustion - especially exhaustion - and people will try almost anything, however irrational, to make it stop. ...

But after recovery, after they have chosen to live, these same people often truly live - passionately, in a way many other people never achieve. Survivors embody extremes of human experience such that every day misery is a stranger to them.

At first, their pain is much worse than our everyday misery, by a factor so large that it would be difficult for most to conceive of it. And then later, after recovery, everyday misery is simply unacceptable. Life must be a passionate, conscious journey, or it is just not worthy the survival effort.

Survivors inevitably address certain questions. Does anyone truly care about anyone else? Is love just a word? On this planet, is it possible to be in control of anything? Is it alright not to be in control? Does human life, in its pain and vulnerability, contain something that makes it worthwhile?

These questions are not asked philosophically, from the relatively detached stance the rest of us may enjoy at times, but rather from a position of intense and consuming personal relevance every day.

Perhaps most instructive of all is the recovered trauma survivor's intimate relationship with what is for many people the most distant of philosophical concepts: awareness of the truth. That awareness is life-giving, that dissociation and numbness are lethal is a lesson the recovered survivor has learned down to his/her bones. It is the lesson that sparks the missionary's glint. It restores faith, and makes living a workable choice. And though the turnabout may seem ironic, this lesson is precisely the one that many of us have not learned deeply enough to make genuine living possible.

Imagine that you are in your house - no - you are locked in your house, cannot get out. It is the dead of winter. The drifted snow is higher than your windows, blocking the light of both moon and sun. Around the house, the wind moans, night and day.

Now, imagine that even though you have plenty of electric lights, and perfectly good central heating, you are almost always in the dark and quite cold, because something is wrong with the old-fashioned fuse box in the basement.

Inside this cobwebbed, innocuous looking box, the fuses keep burning out, and on account of this small malfunction, all the power in the house repeatedly fails. You have replaced so many melted fuses that now your little bag of new ones is empty; there are no more. You sign in frustration and regard your frozen breath in the light of the flashlight. Your house, which could be so cozy, is cold as a tomb.

In all probability, there is something quirky in the antiquated fuse box; it has developed some kind of needless hair trigger, and is not really reacting to any dangerous electrical overload at all. Should you get some pennies and use them to replace the burned-out fuses? That would solve the power-outage problem. No more shorts, not with copper coins in there. But using coins scuttles the safeguard function of the fuse box. What if the wiring in the house really is overloaded somehow? A fire could result, probably will result eventually. ...You almost imagine there is smoke in your nostrils right now.

So, do you go back upstairs and sit endlessly in a dark living room, defeated, numb from the cold, though you have buried yourself under every blanket in the house? No light to read by, no music, just the wail and rattle of the icy wind outside? Or, in an attempt to feel more human, do you make things warm and comfortable? Is it wise to gamble with calamity had howling pain? If you turn the power back on, will you not smell non-existent smoke every moment you are awake? How will you ever risk going to sleep?

Do you sabotage the fuse box?

I believe that most of us cannot know what we would do in such a situation that required such a seemingly no-win decision. But I do know that anyone wanting to recover from psychological trauma must face just this kind of dilemma, made even more harrowing because the circumstances are not anything so rescuable as being locked in a house, but rather involves a solitary, unlockable confinement inside the limits of his/her own mind.

The person who suffers from severe trauma disorder must decide between surviving in a barely sub lethal misery of numbness and frustration, and taking a chance that may well bring her a better life, but that feels like issuing an open invitation to the unspeakable horror that waits to consume her alive. And in the manner of the true hero, he/she must choose to take the risk.

Trauma changes the brain itself. Like the outdated fuse box, the psychologically traumatized brain houses inscrutable eccentricities that cause it to overreact - or more precisely, mis-react - to the current realities of life. These neurological mis-reactions become established because trauma has a profound effect upon the secretion of stress-responsive neurohormones such as norepinephrine, and thus an effect upon various areas of the brain involved in memory, particularly the amygdala and the hippocampus. ...

Overwhelming emotional significance registered by the amygdala actually leads to a decrease in hippocampal activation, such that some of the traumatic input is not usefully organized by the hippocampus, or integrated with other memories. The result is that portions of traumatic memory are stored not as parts of a unified whole, but as isolated sensory images and bodily sensations that are not localized in time or even in situation, or integrated with other events.

Exposure to trauma may temporarily shut down the region of the left hemisphere of the brain that translates experience into language, the means by which we most often relate our experiences to others and EVEN TO OURSELVES.

A growing body of research indicates that in these ways, the brain lays down traumatic memories differently from the way it records regular memories. Such memory fragments are wordless, placeless, and eternal, and log after the original trauma has receded into the past, the brain's record of it may consist only of isolated and thoroughly anonymous bits of emotion, image, and sensation that ring through the individual like a broken alarm.

Worse yet, later in the individual's life, in situations that are vaguely similar to the trauma - perhaps merely because they are startling, anxiety-provoking, or emotionally arousing - amygdala mediated memory traces are accessed more readily than are the more complete, less shrill memories that have been integrated and modified by the hippocampus and the cerebral cortex. Even though unified and updated memories would be more helpful in the present, the amygdala memories are more accessible, and the trauma may be "remembered" at inappropriate times, when there is no hazard worthy of such alarm.

In reaction to relatively trivial stresses, the person traumatized long ago may truly feel that danger is imminent again, be assailed full-force by the emotions, bodily sensations, and perhaps even the images, sounds, smells that once accompanied great threat.

In the next heartbeat, a long-entrenched dissociative reaction to the false emergency is triggered to protect the individual from the unbearable past trauma. This can produce sensations of moving in an uncomfortable, hazy dream or the individual may completely depart from the self for awhile, continuing to act, but without self-awareness.

Most of us do not notice these experiences very much. They are more or less invisible to us as we go about daily life, and so we do not understand how much of daily life is effectively spent in the past, in reaction to the darkest hours we have known. Nor do we know how swampy and vitality-sucking some of our memories really are. Deepening the mire of our divided awareness, in the course of a lifetime, such protective mental reactions acquire tremendous HABIT STRENGTH. These over-exercised muscles can take us away even when traumatic memory fragments have NOT been evoked. Sometimes dissociation can occur when we are simply confused or frustrated or nervous, whether we recognized our absences or not.

Typically, only those with the most desperate trauma histories are ever driven to discover and perhaps modify their absences from the present.

On account of our neurological wiring, confronting past traumas requires one to re-endure all of their terrors mentally, in their original intensity, to feel as if the worst nightmare had come true and the horrors had returned.

All the brain's authoritative warnings against staying present for the memories and the painful emotions, all the faulty fuses, have to be deliberately ignored, and in cases of extreme or chronic past trauma, this process is nothing short of heroic.

It helps to have an awfully good reason to try, such as suffocating depression or some other demonic psychological torment. Perhaps this is a part of the reason why philosophers and theologians through the centuries have observed such a strong connection between unbearable earthly sorrow and spiritual enlightenment. This is a timeless relationship that psychologists have mysteriously overlooked.

All human beings have the capacity to dissociate psychologically, though most of us are unaware of this and consider "out of body" episodes to be far beyond the boundaries of our normal experience. In fact, dissociative experiences happen to everyone, and most of these events are quite ordinary. For example, many people are completely dissociated when watching movies. Effectively, they go into a trance and identify with a character in the movie. At the end of the movie, the individual may notice that he/she has spilled popcorn, and he will suddenly remember all the details of his own "real life."

What happens is that, for a little while, the movie-goer took the part of himself that is focused on everyday reality, and separated it from the imaginative part of himself so that the imaginative part had dominance He/she dissociated one part of himself from another.

Plainly stated, under certain circumstances, ranging from pleasant or unpleasant distraction to fascination to fear to pain to horror, a human being can be psychologically absent from his or her own direct experience. We can go somewhere else. The part of consciousness that we nearly always conceive of as the "self" can be not there for a few moments, for a few hours, or even for much longer.

The physiological patterns and the primary behavioral results of distraction, escape, dissociative state, and trance are virtually identical, regardless of method. The differences among them seem to result not so much from how consciousness gets divided as form how often and how long one is forced to keep it divided.