For trauma victims, surviving an attack or disease can seem like the whole battle. But author Laurence Gonzales says "ongoing survival requires relentless attention." He joins us to discuss coping with the after-effects of trauma on Chicago Tonight at 7:00 pm.
Read an excerpt from his book, Surviving Survival:
No Way Home
Debbie Kiley was a sailor in her twenties when her ship went down in a hurricane. The captain’s girlfriend, Meg Mooney, tried to make her way across the listing deck so that she could swim away. A towering wave swept Meg’s sweatpants off and she fell naked into the rigging, which cut through her thigh down to the bone. -Debbie had already leapt into the water, which now filled with Meg’s blood. As Debbie watched, Meg screamed and another wave collapsed upon her, again sending her into the wires. Debbie swam back to the boat to help Meg into the water.
The first mate, Mark Adams, panicked. He inflated the life raft before tethering it to the ship. It blossomed into a perfect kite, and the gale-force winds whipped it away, carrying Mark with it until he was able to let go. Another crew member, Brad Cavanagh, managed to get an 11-foot Zodiac into the water. The five crew members swam for that boat. All the supplies for survival had been lost with the raft. They had nothing to sustain them. They were as good as dead.
Deep inside the brain, the hypothalamus monitors your bloodstream, its pressure and volume as well as how much salt is in it. When you become dehydrated and the hypothalamus sends its command to drink, it is nearly irresistible. Debbie described it this way: “Thirst begins as an urge, a need, a want, but after a while, it becomes an all-consuming passion, then an incandescent pain that begins in the nose and mouth and eyes and spreads to consume the whole body.” Debbie and Brad were able to resist this torture. Mark and the captain, John Lippoth, were not; they drank seawater on the third day. Within 24 hours they both went mad. They began hallucinating and became convinced that they were a short distance from shore. John began talking to Meg in a calm and seemingly rational way, saying, “I’m just going to get the car. We’re just off Falmouth.” He went over the side. Debbie screamed at him to stop, but he calmly said, “I’ll be back in a few.” Brad joined Debbie in trying to talk John out of going, but he replied, “I can’t take this anymore. I’m going to get the car.” And he pushed off into the sea.
The sun was setting. Thin decks of cloud lay upon the horizon like crimson smoke. In a few moments, they heard John’s shrieking as he was eaten alive by the sharks that had been circling the Zodiac. Meg lay in the bottom of the boat, covered in saltwater and seaweed, naked from the waist down. Debbie could see how severe her injuries were, her leg and torso deeply lacerated by the ship’s rigging. Later that night, when Mark climbed on top of her in his delirium, all Meg could do was whimper. Then Mark flew into a rage, screaming, “I’m tired of playing games. I’m going back to the 7-Eleven to get some cigarettes.” He, too, slipped over the side. Everything was quiet for a time. Then the Zodiac was hammered from underneath and flung into the air. A second concussion spun the boat around, lifting the bow and slamming it back onto the surface of the water. Debbie and Brad lay in the bottom of the boat, holding each other in terror, as they realized that sharks were in a feeding frenzy over Mark, just below the hull.
Full night descended, and above the moonless ocean the Milky Way emerged like a faint galactic mist in the sky. All was quiet once more. New stars drifted along their upward trajectory. -Debbie and Brad fell asleep together. She woke to the sound of Meg speaking incoherently as if in tongues and waving her hands in the air. Meg seemed at peace, her voice without inflection. Soon the muttering ceased and Meg closed her eyes and stopped breathing. Brad and Debbie committed her body to the sea. They then made a pact to look out for each other, to take turns sleeping, not to drink seawater. To survive.
The next day, their fifth without water, they were picked up by a Russian freighter 290 miles off Cape Hatteras. When I told that story in my book Deep Survival, that’s where it ended: with the rescue. But the rescue marked the beginning of an entirely new story for Debbie, because a relentless system for making memories had been hard at work throughout her ordeal. She endured excruciating pain over the course of the five days she spent adrift at sea. In addition to the pain of thirst, the terror, the physical brutality of the sea, she witnessed the horrifying deaths of three friends. Much of what the brain does is unconscious. It works behind the scenes to forge memories of what is dangerous and what is beneficial so that in the future we can respond correctly and automatically. During her crisis, Debbie’s brain was working overtime to map out those memories in preparation for the next assault. In the brain, the cardinal rule is: future equals past; what has happened before will happen again. In response to trauma, the brain encodes protective memories that force you to behave in the future the way you behaved in the past. Any sight, sound, or smell, any fragment of the scene in which you were threatened, can set off that automatic behavior. The trouble was that in all likelihood, Debbie would never again face a similar hazard. It is rare to be shipwrecked. The chances of its happening twice to the same person are vanishingly small (though, as we’ll see, that can happen sometimes). In other words, Debbie’s natural and normally useful systems for forming important memories were working on a job that had no practical value. Indeed, those systems were working to make her miserable.
After their rescue, when they were out of the hospital, -Debbie and Brad, the sole survivors, went to lunch with their families. It was a celebration. They had survived. They were going home. But after the meal, Debbie and Brad walked away from the group and down to the harbor to look out and say good-bye. “Somehow,” -Debbie later said, “we couldn’t fit in with those people, we couldn’t yet return to the world.” That clearly echoed what Viktor Frankl wrote about being liberated from a Nazi death camp at the end of World War II: “We did not yet belong to this world.” That is one of the most common sentiments people express after an experience of extreme survival. Frankl said that when he and his fellow inmates were freed from the horror of the Nazi death camp, they experienced no joy. Their first steps into the world were timid and tentative, and they were not yet able to trust their own freedom. Although they passed through fields of flowers, they were unable to form an emotional reaction to them. The men came together that evening to examine their feelings about liberation and discovered that they had literally forgotten how to feel anything at all. The experience in the camp had inscribed a set of memories that obscured the old. The memories of survival had to be slowly overwritten by a newer layer of experience. Only then could freedom be trusted.
Dougal Robertson drifted in a life raft for 37 days, trying to keep his young family alive after their sailboat, the Lucette, sank. The parents and four children were picked up at last by a fishing boat. Safe on deck, Robertson said he felt “like a merman suddenly abstracted from an environment which has become his own and returned to a forgotten way of life among strangers.” Those feelings of alienation and displacement represent one of the most common responses to trauma. Just ask Jessica Goodell, a Marine who served in Iraq. Her job with Mortuary Affairs was to reassemble human bodies that had been blown apart by roadside bombs so that they could be sent home. After eight months of that horror, she tried to go home but realized that she, too, felt that there was no place for her in the world. After being trapped underground for 69 days in 2010, a Chilean miner expressed this same sentiment. “Part of me stayed down there,” he said.
Survival is one triumph, but living through that ordeal delivers us into the next stage of the journey. Adaptation means adjusting the self to a particular environment. If the environment changes, as it does through the experience of trauma, you are lost and must adapt once more. The bigger the trauma, the more dramatic the requirement for change. In many cases, the necessary adaptation is so extreme that an entirely new self emerges from the experience. In those cases, there is no easy return to the old environment. Sometimes you can’t go home at all.
It is nearly impossible to live a full life without trauma. It may not be a shipwreck or war. It might be a husband who tries to kill you. It could be a bear that tears off half of your face. It might be cancer. But all such events share a dramatic quality that seems irresistible to the storyteller within us. The stories always end like this: Just when Debbie and Brad seem doomed, the Russian freighter heaves into view and they are rushed to the hospital. Music up. Roll credits. Then they all live happily ever after. Offstage, of course. But let’s put the players back on stage and see what happens next.
Debbie Kiley flew to New Orleans to recover at her mother’s home. While still on the plane, she began reliving the moments when the captain, John Lippoth, mad from drinking seawater, began talking about going to get the car. She could see him climbing over the side and slipping into the water. She watched him appear and disappear in the swells as he swam away. Merely closing her eyes brought the saturated images before her. She could still hear his horrifying screams like outraged metal as he was eaten alive by sharks. Each time the plane hit a bump, she said, “It felt as if someone was standing on my chest.” During her five days adrift, she had used pleasant daydreams as a way to distract herself and to cope with the pain and terror. Now she couldn’t rid herself of the powerful illusion that she was still at sea. The airplane ride was just another dream. Echoing Robertson, she later said, “It was as if some part of me still lived, could only live, on the raft, adrift at sea.” That made perfect sense in terms of the parts of the brain concerned with survival: It would store away as much information as possible for future use. Debbie just wanted it all to go away. Her system for forming protective memories had done its job too well and had split her in two. Now her job was to knit herself together again.
She managed to get through the plane ride without going mad, but once she reached her mother’s house, she lay in bed for days. She carried glass after glass of water back to the bedroom. An inner compulsion made her drink half of each glass and leave the rest to reassure herself that there would be more. After a week in bed, -Debbie forced herself to go outside. This is the self divided by trauma: The rational part of her brain knew that her behavior was odd.
Out on the street, all the sights and sounds and people were too bright, too loud, overwhelming her senses. “I felt like I was not really there,” she said, “or didn’t belong there. I felt like I was on the verge of insanity.” She went to St. Louis Cathedral and sat in a pew and released herself at last to uncontrollable sobbing. Debbie wondered how she would ever get back to her own life. But as she was to learn, you cannot return from a journey such as hers. Your only choice is to go forward.
Debbie spent most of that first month weeping in the cathedral. Angry and frustrated with herself, she decided to head back out to sea and confront her fears directly. She signed onto a boat that serviced other vessels during races. A storm broke over the race, sinking a number of boats and killing several sailors. Debbie returned worse off than before. She spent almost all her time hiding in church, praying and weeping. She tried getting a job and going back to school. She would be all right for a time, “white knuckling it,” as she put it. But almost any adverse event would send her into panic. She would exhaust herself, fall into depression, and then lock herself in her apartment and cry for days on end. Over the coming years, she attempted many strategies. She tried getting married. She tried pregnancy and childbirth. And she still stood in the shower sobbing each morning. The constant stress began making her physically ill.
As Debbie told me about the nightmare in which she’d become trapped, I began to wonder what determined who did well after survival and why. I wanted to know what natural systems in our brains could make us respond the way Debbie had and what we could do to get on with our lives. Some people are innately more resilient than others in the wake of catastrophe. But we can also take steps to help ourselves. It turns out that many of the beliefs about this subject that psychotherapists have long held sacred are simply not true. For example, when the World Trade Center was attacked, the Federal Emergency Management Agency spent $155 million to make psychological counseling available to anyone who wanted it. The experts thought that a quarter of a million people would seek help for unmanageable grief over lost loved ones or for debilitating anxiety as a reaction to the horror they had witnessed. Just 300 people showed up. Of course, more people may have been in need of therapy, but new research suggests that if the bad news is that most people will experience trauma, the good news is that the majority are able to go on with their lives. Richard Tedeschi, a professor of psychology at the University of North Carolina, says that most people return to normal within two years after trauma. James Pennebaker, a social psychologist at the University of Texas, called this fact “one of the best-kept secrets in the mental health world.” But the quality of life during those two years can be drastically different if you employ sound strategies for moving forward. After major trauma, few people find an exact fit into the old way of life. And this means that you face the task of building a new life and, in some cases, as we’ll see, even a new sense of who you are.
Your experience of life in the aftermath may be even more dramatic, sometimes more painful, than the experience of survival itself. But it can be beautiful and fulfilling, too, and a more lasting achievement than the survival that began it all. What comes after survival is, after all, the rest of your life.
Reprinted from Surviving Survival: The Art and Science of Resilience by Laurence Gonzales. Copyright © 2012 by Laurence Gonzales. With the permission of the publisher, W.W. Norton & Company, Inc. All rights reserved.