Alicia Salzer















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Back to Life book by Dr. Alicia SalzerIntroduction

As children we see the world with a sense of wonder. We imagine that we are princesses or superheroes, and we inhabit those roles with conviction. As adolescents we fall wildly and romantically in love. We plan our lives and plot our dreams, and we bask in theassurance that we will become who we are meant to be. What happened to that passion and vibrancy? Well, life happened—disappointments, setbacks, tragedies. We don’t often stop to consider these collective losses and what causes them, but accumulate too many of them and life starats to feel dull and hard.

Most of us have had experiences in our past that we feel have changed us forever and changed us for the worse. Many of us look in the mirror and see a person who has become bitter and angry or fearful and uncertain. We have trouble getting past our pasts. We continue to feel thin-skinned, damaged, powerless, ashamed. Life certainly takes its toll.

Yet in our midst are people who do overcome life’s tragedies and challenges and do so with apparent grace. We read their biographies. We go to hear them speak. We watch them on TV and we ask ourselves: How did they do it?

How does a person live through a life-altering challenge yet emerge still self- possessed, still hopeful, still empowered? How did they retain—or regain—a sense of safety and trust?

For us, the people on those TV shows are a real mystery. We scan their faces and stories for clues, onging to know what they have that we don’t have and whether it’s possible to get there from here. What gave them the courage to move forward? How did they lay the anger to rest? How did they find purpose from something so senseless? What did they think and do in their darkest hour to get them back to the positive place they seem to be in now? How did they overcome?

Unfortunately, the “how” doesn’t make for good television, so we tend to see the wretched “before” and the glorious “after” punctuated by an epiphany that miraculously turned their life around. This makes it seem like some kind of healing magic appeared in their lives and helped them get past their past.

In fact, they are working hard to earn the ease with which they seem to move through life. They are practicing the art of survivorship. They know what and who makes them feel good, safe, and vibrantly alive and they pursue those things and people with discipline and vigor. They know how to soothe themselves, how to reassure themselves, how to restore their own sense of self, their faith, and their ability to cope. When we look at these people, these resilient overcomers, we tend to notice their impressive actions. But what I find most significant and compelling is the way these survivors take charge of the thoughts that they allow to inhabit their minds, the emotions that they cultivate in
their hearts.

Back to Life book by Dr. Alicia SalzerResilient survivors have a special way of thinking about what they have been through that enables them to thrive.

And everything they know, you can learn. In the course of my work, I have met a lot of heroes, some famous, most not, who have taken the challenges of being human and woven from them a life in the aftermath that is a magnificent tribute to the resilience of the human spirit. I am always looking—just as you are—for the “how.” And I have found some concrete answers that really help.

As a psychiatrist I have focused on trauma for the past ten years. At times I have found myself in the trenches with my patients in the immediate aftermath of major psychological trauma. I have worked as an attending psychiatrist in the psychiatric emergency room of a New York City hospital where people turn when their life is at its very worst. I have worked with disabled New York City mass transit workers who sustained psychological trauma on the job. After my hometown was attacked on September 11, I worked with an organization called Disaster Psychiatry Outreach and treated hundreds of New Yorkers. At first I volunteered at Ground Zero, talking with firefighters and paramedics, ironworkers and neighbors, all of whom had found themselves unexpectedly in a war zone. Later I volunteered at the heartbreaking family assistance center that was set up to help the families of those missing, injured, or killed.

While it is valuable to help support and advise people in the midst of their crisis, it is in the months and years afterward that real progress is made, as they struggle to get back to a life that a psychological trauma derailed. It is in the long term that certain individuals emerge who seem blessed with an ability to move forward with grace. For three years after 9/11, I worked at the Mount Sinai World Trade Center Clinic, which provided free treatment for Ground Zero rescue workers and volunteers. I also worked, for five years, as the trauma expert and aftercare director for The Montel Williams Show, where I had the opportunity to meet and to help hundreds of remarkable survivors. In my years as a trauma psychiatrist, I have had the opportunity to see people at their very worst and their very best. What moves me most is when a person finds a way to be simultaneously both. But make no mistake, the people we call heroes face doubts, just like the rest of us; they have lost hope, and floundered, and fallen on their faces, too.
But they have specific skills and strategies that they implement in moments of doubt and crisis and they utilize these skills in a way that is part life raft and part religion.

A rare few heroic overcomers seem to have been born with an intuitive sense of how to surmount life’s psychological traumas; maybe they were taught some of these skills in childhood. But most of them made an active decision that enough was enough. At which point they took control over the thoughts they allowed to inhabit their heads. It’s an impressive discipline that they have cultivated, but there is no bar to admission. Everyone can learn the habits they practice and the outlooks they take. Everyone can try on the skills that these resilient survivors use in the face of life’s inevitable challenges.
And everyone can use them to feel better.

I use the word trauma a lot in this book. As in, “life’s traumas came along and robbed you of your sense of hope.” For many the word may sound alarming. What exactly qualifies as a psychological trauma?

Back to Life book by Dr. Alicia SalzerFor the purposes of this book, a trauma is any event or situation that fundamentally shakes our understanding of the world and of our place in it.

Certainly this includes all the horrors that one typically thinks of when the word “trauma” is used. But in my opinion it also includes a host of other experiences that leave us reeling because the “rules” of life seem to have suddenly changed. In this view, a trauma might be a health issue, a betrayal, the loss of an apartment or job. When a life event robs you of your sense of well-being and self-esteem and leaves you feeling unsafe or out of control—that’s a trauma, too.

But it’s important to acknowledge that when we speak of trauma there are really two different things we are referring to. There’s the traumatic event itself, and then there’s “take-home trauma,” the way that the trauma changes our views, the rules we live by, and the way we see ourselves. The long-lasting casualties after trauma are the spiritual, emotional, and cognitive hits you’ve taken—and how those changes affect how you subsequently move through the world.

Traumatic events pose a challenge to our sense of justice and order; a world that once seemed fair no longer does. You thought that if you were loyal and caring that your marriage would work, but it didn’t—and now you feel less able to love and trust. You thought you were making smart investments, but losing the bulk of your savings has made you feel unsure that your intelligence is a sound guide. Somehow, the rules have changed: because of your experiences, you can no longer believe that being careful will keep you safe, or that a healthy lifestyle will keep you well.

Back to Life book by Dr. Alicia SalzerIt’s important to distinguish between the trauma itself and the “take-home trauma.”

This rule-changing that underlies the take-home trauma is devastating. Sometimes it feels as if there’s a ghost life running right next to yours on a parallel track. You can see very clearly the person you should have been, the person you would have been if it hadn’t been for the trauma, and you can see, very clearly, everything you lost.

When we try to live by these new rules it feels like the ground has become shaky under our feet. This state consists of a blend of grief, anxiety, and distrust that I call living in permatrauma. In an attempt to protect ourselves from a recurrence of the trauma, we adopt maladaptive behaviors, bringing the lessons we learned on the worst day of our lives—distrust, a lack of self-confidence and selfefficacy, a feeling of victimhood—to every day afterward. We stop doing things; we stop trusting people. And we cling to these maladaptive behaviors long after the storm has passed, not realizing how this perpetuates our sense of disempowerment and danger.

As these maladaptive strategies become habits, our lives get really, really small. Suddenly, there’s a lot of stuff you don’t do anymore. But more importantly, there’s a lot of stuff you don’t feel anymore, as your repertoire of emotions shrinks to be more congruent with this new permatrauma worldview.

The rules we make for ourselves after trauma feel like they protect us, but they really narrow our emotional range. Essential emotions like safety, trust, love, tenderness, intimacy, and empowerment often fall by the wayside. Yet these emotions are precisely the things we need to feel in order to lead a full and fulfilling life. That’s why the real wages of trauma occur in the aftermath.

Back to Life book by Dr. Alicia SalzerTrauma narrows our emotional bandwidth. That’s why the spiritual and emotional costs are the focus of this book.

It’s not easy to be a loving and supportive parent or partner from a state of fight- or-flight. It is impossible to experience intimacy while keeping someone “safely” at arm’s length. If you’re white-knuckling your way through life, it’s going to be very hard to feel grateful, or creative, or to laugh until you cry. If you have embraced the notion that you are a victim, you cannot feel empowered, emboldened, or fierce. Over the course of this book, you will come to see that these “lost emotions”—and the activities they allow us to enjoy, the relationships they allow us to have—are what make life worth living. Permatrauma takes them away, but you can take them back.




All content © Dr. Alicia Salzer 2011, Author Back to LIfe: Getting Past Your Past with Resilience, Strength and Optimism
Website by Little Bones Media | Author photos by Erica Freudenstein