And while the trauma may have inflicted physical damage, that doesn’t mean it can be prescribed away with medication. There’s no shortcut. Healing takes time.
“We need to understand that this is a physical injury to the brain and to the sympathetic nervous system,” says Ochberg. “There are ways to encourage people who have that component of PTSD to recover joy and bliss and love and pride, but that’s a tough slog. And there aren’t any pills that can really give you that.”
There are, however, progressive places like Interim House, a women-only recovery center that sits on a tree-lined street of Philadelphia’s Mt. Airy neighborhood. It’s respected around the country as an innovative leader in the use of trauma-informed therapy. It’s here that I met Sophie and Ann Marie, the former of whom was in the tough slog—the latter of whom was working there.
At a meeting with staff, when they’re asked to estimate how many of their clients were neglected or abused as a child, the counselors look around at each other hesitantly before agreeing: practically all of them.
Interim House counselor Jen Valentine points to the book Trauma and Recovery: The Aftermath of Violence—from Domestic Abuse to Political Terror, by Judith Herman, M.D., an expert in the field of complex PTSD. “This is like our bible,” she says.
Valentine says many of the women who come through Interim House are familiar with “the life.” She tries to open the dialogue early with her clients, so they can start talking about it. She explains how she looks for evidence of trauma in a new client: “Things like disassociation… [a new] persona develops. If you’re living on the street, it’s, ‘I’m tough, I don’t feel anything and I don’t care about people, and nothing touches me and nothing affects me.’ That’s a very common thing to develop, to protect yourself from dangerous situations or fear. It’s a way to deal with negative emotions.”
Clients at Interim House need to learn how to cope with stress—to recalibrate their minds and calm their bodies down enough to function in an atmosphere of relative safety. (Meanwhile, health insurance companies continue to reduce the length of time in therapy they’ll cover.)
In working through trauma-informed therapy at Interim House, Anne Marie has learned about how events of her life piled on top of one another, burying her underneath. “I wasn’t born and said, ‘OK, I want to be a drug addict,’” she says. “A lot of things happened to me in my life, and once I tried the drug, it was like, ‘Wow, that really helps me—that makes me feel nothing at all.’”
Through everything, from 13 to 44 years old, Anne Marie kept her promise to her mother. She never told anyone about her abuse—until she came to Interim House. “At first I wasn’t willing to open up and talk about it because I was scared, and didn’t trust nobody,” she says, “but eventually I started to let go a little bit, and now—now it’s like I can talk about it … that’s helped me a whole lot.”
She struggles to describe what it feels like to be addicted to danger, to life in the streets. “[It] can grab a hold of you just as much as the drug can,” she says. “It feels like—you might not be using the drug at that moment, but the lifestyle is kind of taking the place of the drug, and numbing everything that’s going on. It’s hard to explain. It really is hard to explain, but it’s hand in hand. It’s like an adrenaline thing.”
Sophie agrees: Once you adapt to the life, you know who you are there. The chaos matches the brain’s expectation of chaos—which is an odd relief. “Even certain music today makes me think of being out there,” she says. “You feel free. You don’t owe nobody nothing, you don’t have to care about anybody but yourself. You’re not accountable to anybody or anything.”
Sophie recalls that, for a long while after waking up, she couldn’t connect with people. She moved in with family, but found it difficult to be around people who cared about her. But Interim House helped; now she can rattle off the therapies she learned there, which she credits for enabling her to spend 13 months clean. “Dialectical behavioral therapy helps me deal with interpersonal conflict,” she says. Then there’s “SAGE,” a type of cognitive behavioral group therapy: “It’s always about me keeping myself safe, which I never did my whole life,” says Sophie. “I never kept myself safe—it was always me and danger. I know that Interim House is always here for me, and I always want to stay connected.”
After open-heart surgery in 2010, Sophie relapsed one more time. “I went in and out of detox and rehab,” she says. “I got nine months clean, I relapsed. Finally I came to a decision that I needed to get clean—it was either do or die. I was back down West Philly, facing the same stuff that I did before, and I just didn’t have it in me no more.”
She spent six months at Interim House, then moved into Dawn’s Place, a long-term residency house for trafficked women. She’s had to learn about the way her body works—to not seek out the chaos her nervous system has been conditioned to expect. She doesn’t like to be around loud voices or in a room with a lot of people talking at once. She’s nervous when people stand behind her.
She says her outpatient therapy keeps her going on course. She’s trying to figure out what job to train for, but her options are limited because of her criminal record. Still, she’s in her second semester of college. “It’s beyond my wildest dreams,” she says.
Anne Marie’s in school, too, and working as a staff member at Dawn’s Place. She recently had family over to her house for a holiday dinner. Someone said to her: “We got Anne Marie back.”
*Name has been changed for privacy.
Tara Murtha and Randy LoBasso also reported a radio story on this topic for WHYY / Newsworks as part of a multimedia mental health journalism series made possible by the Thomas Scattergood Behavioral Health Foundation.
Letters to the Editor