struggling with complex trauma and what to do
July 15, 2021 9:43 AM   Subscribe

I've been dealing with ADHD, depression, and anxiety for years now with therapy and medication. Meanwhile, my psychiatrist has been giving me gentle nudges in the direction of looking at all this as a consequence of trauma. In the last couple of months I've finally read about C-PTSD, and come to the realization that I am likely a classic case of childhood emotional neglect. Unfortunately, this breakthrough is now making life extremely hard for me- particularly with work. Looking for perspectives and experience.

Essentially, I have realized that I grew up in a total emotional void. Emotionally immature, narcissistic mother, depressed and distant father. Never any active abuse, but constant low-grade reinforcement of the idea that my emotions, at best, just didn't matter, and at worst, were an inconvenience. As far back as my memory goes, any kind of emotional disclosure was held back for fear of it being ignored or minimized. When my parents finally split up, I was told "Dad has gone to stay with his mother for a while". I never asked any more questions. I probably didn't see him for 6 months after that.

It went beyond emotions. I also suppressed basically any expression of desire or need. I remember once getting a searing pain through my groin and abdomen that had me curled up and whimpering for half an hour, and I never mentioned it to anyone for fear of being seen as a bother. I think I was twelve.

From the outside, everything looked fine. My material needs were provided for, I did very well at school. Extracurricular activities were planned for me, and I did them without complaint. Even enjoyed some of them.

Since then, I've continued to do well. Went to university, got a well-paying job that's at least half interesting, and I've been promoted as high as I can be on a technical path, I report to a VP, and my work is becoming visible to the C-levels. The whole time, I've been suppressing feelings of depression, isolation, anxiety, and inadequacy. Meds are helping, but now that I have finally realized the source of all this, I feel like I'm drowning. I stare at the screen and my mind goes blank to avoid all the negative thoughts. If I let myself think the thoughts, I get overwhelmed with emotion. I've realized that anxiety has been a primary driver for me, backed up with enormous amounts of avoidance, and now that both are more under control I don't have any other coping mechanisms. On top of all this is the shock of the realization, and the questioning of things I'd accepted as fundamental, like whether I even have ADHD (it was diagnosed as an adult, well before anything that looked like trauma became evident to me).

I've never had to figure out what I want, or be proactive about anything, since I've always just gone with what life brings to me. And from the outside at least, that's worked pretty well. But now I'm in a role where I need higher functioning executive ability, and I'm just floundering. And what's making it harder, is that I've been getting away with it for the past six months or so because my boss has been tied up in other things, and generally trusts me to deal. So there's no external indication that this is all going on (I've been working 99% remotely).

My psychiatrist has recommended an intensive outpatient trauma program, which I've just been to an intake interview for. I know this can probably help. I'm facing two major hurdles about it.

The first is that every time I read the program description, or think about the questions that I was asked at the intake, I can't get over thinking that I'm "not traumatized enough" for this kind of thing. The thought of having to sit next to someone who experienced "real" abuse and has suffered in an outwardly visible way seems impossible to deal with. I know this is exactly the kind of feeling that doing the program would quickly invalidate, but holy crap I just can't get past it.

The second is logistical. The program is 9 am-12 pm, three to five days a week, for up to eight weeks. I know I could swing it with some combination of full days of PTO, half day PTO, or time-shifting, and my manager would likely be ok with it once I made clear it was a personal thing. But I'm also really struggling with whether to disclose to my manager that I'm even needing help, and that this would be part of it. Especially since there's no outward sign of my problems so far. I worry that the additional load of the program will make it even harder to cope with work if I try to do even half days after sessions. And there will be a bunch of questions from all angles about what I'm doing with all that time off. My company has a generally good attitude about mental health stuff, but I know that disclosing that I'm not coping and needing time off for help is not something that can be reversed.

So, this got large. I'd love any feedback about ways out of this, good experiences from people in similar situations, particularly the work stuff.
posted by anonymous to Health & Fitness (20 answers total) 19 users marked this as a favorite
So this isn’t really answering your question except maybe from the standpoint you think you might not be traumatized enough- I have a VERY similar childhood but with a sick mother thrown in and some weird stuff. My childhood came up in therapy recently and I just couldn’t deal with it and even though he told me to put it in a box and not think about it until the next session I just couldn’t deal with it and I asked to take a break. So I guess my point is that it’s definitely worth trying to work out the logistics. I have a feeling that, like you, it may have effected me in deep deep ways I’m only beginning to understand.
posted by pairofshades at 9:58 AM on July 15 [3 favorites]

I think that Alison Green at Ask a Manager, who seems to give very good advice about work, typically advises not to get into the nuts and bolts of the contents of your medical care with your workplace. "I will be needing X, Y, Z time off/arrangements for some medical appointments" is all they need.
posted by theatro at 10:06 AM on July 15 [11 favorites]

A lot of this resonates. A few thoughts:

- I highly recommend reading Running on Empty and Adult Children of Emotionally Immature Parents It was pretty impactful for me, and realized how much neglect I had, even if it didn't manifest materially.

- It's helpful to understand that one can receive material support and still be emotionally neglected. In fact, part of my process has been to understand what not being emotionally neglected could even look like.. and to grieve, and to accept it. I wonder (if you're like me), and this will be hard to hear, that the bar for emotional acceptance and understanding for you is so low, that you might not even know what you're lacking. Freud called this melancholia, and I think there's something to it - "grieving for a loss we do not fully understand."

- Are you seeing a therapist, not just a psychiatrist? Someone whom you can talk about these issues? To me, therapy is about modeling a relationship I want, and my journey has been to (very very slowly) be able to talk about these aspects with a therapist, and to model/receive/act out the kind of emotional care I need.

- But I'm also really struggling with whether to disclose to my manager that I'm even needing help, and that this would be part of it.

This is a major part of your life; it has structured who you are, and I think, relative to how pivotal it has been, it sounds like you haven't looked at it directly. In many ways I think we owe it to ourselves to take care, be gentle, and take the time we need. If your finances aren't an issue (and honestly, it sounds like they're not), then I would recommend having a serious conversation and setting aside 3 months to take a break. You could chalk it up to COVID-related family issues that you have to deal with, or frame it however you need to ... or like how theatro mentions above. I wonder, however, if appearing anything less than perfect, or sharing your concerns with others, might feel impossible or undoable; that you might have to present an image of perfection and total independence?

- One concept I read was about 'functional independence' vs 'emotional independence'. Often times, many people (like me) can achieve functional independence -- financially, materially, etc. However, we might not actually have enough healthy emotional separation from our family of origin, leading us to either 1) be hypersensitive to people and our parents, or 2) to be totally distant and cut-off and hyper-functionally-independent as a coping mechanism. So I would gently note that the kind of independence I'm reading between the lines (and definitely projecting myself onto) might stem from this.

- Lastly... where I'm at lately is that, ultimately, your experience have shaped you for who you are, and all of the experiences you've been through have hurt you, but have also given you tools and strengths. I'm a believer that all our strengths are our weaknesses, and our weaknesses are our strengths; and so the task of healing ourselves is actually I think better framed as the task of understanding and knowing who we really are. There's nothing to "fix" about ourselves, but there are misunderstandings about ourselves that we ought to clear up, deep terrifying fears that we have that we should realize and look in the eye.

Godspeed. Feel free to DM me.
posted by many more sunsets at 10:12 AM on July 15 [12 favorites]

Lastly, you might be interested in these two podcast episodes, interviewing Saj Razvi, who specializes in psychedelics-assisted therapy:

They happen to be about psychedelic therapy, but there's a description about childhood emotional neglect (despite material support) that's very vivid, that perhaps you might find a personal resonance with.
posted by many more sunsets at 10:16 AM on July 15 [3 favorites]

There is absolutely no need to disclose that you need the time for mental health reasons. In fact, it's a good thing to reinforce that the details of employee health problems are not the employer's business. The next person with private health issues will be grateful for that.

What you should do, however, is let your boss know what they can realistically expect in terms of work output in the meantime and when you will be back. I know it's hard but don't overpromise out of guilt. It's better to set low expectations. You know this is going to take a toll. Maybe ask you psychiatrist for their opinion on that?
posted by Omnomnom at 10:20 AM on July 15 [6 favorites]

I'm going to pull out two bits from what you wrote and show them to you next to each other:

Never any active abuse, but constant low-grade reinforcement of the idea that my emotions, at best, just didn't matter, and at worst, were an inconvenience. As far back as my memory goes, any kind of emotional disclosure was held back for fear of it being ignored or minimized. [...] I remember once getting a searing pain through my groin and abdomen that had me curled up and whimpering for half an hour, and I never mentioned it to anyone for fear of being seen as a bother.


every time I read the program description, or think about the questions that I was asked at the intake, I can't get over thinking that I'm "not traumatized enough" for this kind of thing. The thought of having to sit next to someone who experienced "real" abuse and has suffered in an outwardly visible way seems impossible to deal with.

I'm sure you can see why I pulled these two things out and put them next to each other, and deep down you already know: the thoughts that you "aren't traumatized enough" were part of a learned pattern of behavior your parents pushed you into, and which is itself part of your trauma.

It may help to just keep reminding yourself of that - that when you think that you aren't really "not traumatized enough" for this, that it is the trauma itself speaking. It's set up camp in your head and it isn't inclined to go away all that easily.

I hear you about this, though. These kinds of painful realizations about one's own life can be ground-shaking at first, and trying to just function while all that stuff is going on inside you can feel super hard.

As for what to tell people at work - how is your HR department? Do you trust them enough to discuss with them that "this is what's going on with me, and I'm not sure how to bring this up with my manager"? I know that often HR gets a bad rap in some circles, but the HR Departments I've worked in were very sensitive to how to balance a workers' own personal life and need for privacy with the company's need to know "what the heck is going on". If you get the sense that HR is a bunch of nosey folks, maybe not, but it may be worth asking your HR department if they can help you sort out how to do this and how much to divulge to your boss.

This is going to be a challenging time; but only because you are fixing up your foundation of your sense of self, in such a way that it will be stronger and you will be stronger going forward. I wish you all the luck.
posted by EmpressCallipygos at 10:23 AM on July 15 [11 favorites]

Nth-ing that, yes, you qualify for this program. I worked in a similar IOP as a social work grad student and conducted intakes; your anxiety about not being "traumatized" or "anxious" or "depressed" enough to be in the program is completely normal, I heard new program members say this over and over again.

As EmpressCallipygos says, this is your trauma speaking. You were hurt deeply, and your body is trying to pretend that everything is normal and okay, but it isn't and you are doing the scary, brave and wise thing to do: you're asking for help.

Thank you for doing that. Just as you'd be making the world a better place by providing the help and support that a friend might need, you're making the world better by taking care of yourself right now. You are being a good friend to you.
posted by tivalasvegas at 10:51 AM on July 15

(IAAT/IANYT) If two people arrive at the ER with a broken arm, but they each got injured in a different way, they are both equally deserving of proper care. Trauma—especially chronic trauma—is much more like that than you might think. The treatment isn’t to undo what happened, it’s to facilitate healing the brain and body it happened to. In a sense, it’s almost beside the point exactly what you experienced. For instance, children who experience serious medical issues at an early age have brains that look very much like children who experience physical abuse at an early age. Trauma is the disruption of your ability to feel safe in your own body. If you are stuck there, you deserve treatment and healing. It's common to have those thoughts of “it wasn’t so bad,” which probably helped you get through hard times, but those thoughts aren’t the truth about what happened and how it hurt you.
posted by theotherdurassister at 10:54 AM on July 15 [10 favorites]

I’ve been in (mental health) therapy for a few years now, and I’m currently in physical therapy for a physical injury. While it’s certainly easier to share the back injury part with co-workers informally, when I formally request time off, I say “medical appointments” or some such. I don’t differentiate. I know it’s common for people to disclose more than is necessary, but you’re not obligated too. And it’s not anyone’s business.

As for whether you’re traumatized “enough” for this program, I hope I’m not sounding flippant when I say it sounds tremendously helpful. A thoughtful, competent professional thinks this program would serve you well. And if it’s somehow more than you need, that seems... great? I hope that makes sense. Like if you had a physical injury and had an hour-long massage, and you were mostly better after 45 minutes, then the extra 15 minutes isn’t wasted on you.

Taking some time away like this sounds incredibly smart and a real act of kindness to yourself. I wish you the best.
posted by bluedaisy at 10:59 AM on July 15 [2 favorites]

Addressing the practical question, assuming this is in the US I believe this kind of treatment would qualify for FMLA (if you otherwise qualify).

No matter where you live, I would follow your local procedures for intermittent medical leave and I would personally disclose this as a 'chronic health issue that has become severe enough to require outpatient treatment' which is the truth. In the US you can get a doctor's note from your therapist, psychiatrist or your GP and your boss should not see that note, it should go through HR only.
posted by muddgirl at 11:01 AM on July 15 [2 favorites]

Also I want to encourage you to consider, and discuss with your therapist, if you should take off 8 weeks completely if that is possible, or take off the first few weeks and then work half days nearer to the end. When I say "if possible" I mean "if possible for your financial situation" not taking your work's staffing needs into account (because that is their concern, not yours).
posted by muddgirl at 11:03 AM on July 15 [5 favorites]

"every time I read the program description, or think about the questions that I was asked at the intake, I can't get over thinking that I'm "not traumatized enough" for this kind of thing."

i've heard a lot of people in your situation say this same thing. it's always a lie your brain is telling you. you deserve intensive treatment, and comparing yourself to other patients isn't meaningful at all. trauma produces symptoms when we experience something that is way beyond our ability to cope/understanding of the world at the time. this can be a lot of different things for different people, and for a child, it doesn't need to be as dramatic or sensational as some of the stories we hear about adults who do things like survive violence or war.

neglect is a true and documented/studied cause of cptsd and you deserve the best treatment you can get your hands on.

please get formal medical leave from your job and take your time with this. your health is invaluable, and the work/promotions will be there when you come back. there is no need to give detailed information about your medical condition to anyone at work, and when people ask you after you come back, you can simply say, "i'm not comfortable discussing that, but i'm glad to be back and feeling better." + topic change
posted by zdravo at 11:04 AM on July 15 [5 favorites]

Oh, and to address the logistical parts a bit:

The social worker or whoever is responsible for the intake stuff should be on top of getting insurance auths and getting any FMLA paperwork signed off on. I don't believe that people typically needed to have their PCP directly involved, usually our program doctors were the ones filling out that paperwork -- but of course this program might be different, and that person's job is to help navigate it with you!

I also suspect that they will at least strongly suggest that you not work at all during the course of the IOP.
posted by tivalasvegas at 11:26 AM on July 15 [1 favorite]

There's no such thing as not traumatized enough. If a program has help for what you are experiencing, you belong in that program. There are people who have experienced much worse parenting than I did, and who have been able to manage much better. And people who seem to have had nice childhoods, but whose level of need is higher. You deserve to feel better. You deserve treatment. You deserve paid time off for this treatment. You deserve(d) competent parenting, love, affection, fun, respect, encouragement, and so much more. If it helps to write affirmations on index cards and tape them to the mirror, do that, because the message that you deserve everything is something ton internalize(telling myself as well as you).
posted by theora55 at 11:35 AM on July 15 [3 favorites]

Also, Mental Health is Health. Mental Health is quite physical, is deeply interconnected with your physical health to the extent that there is little real division. Depression may sometimes be caused by inflammatory illness. Poor mental health leads to physical illness and vice versa. Mental Health is Health.
posted by theora55 at 11:38 AM on July 15 [2 favorites]

You might ping the hospital and your psychiatrist for guidance on taking leave for your treatment, and pull the paperwork to review whatever short-term disability leave you might have - it's possible that your STD coverage has something like a "substance abuse or behavioral treatment program" inclusion, and "behavioral" would probably be the clause that likely covers you here. If you can take the full time off, I suggest you do.

I wish every workplace was clear-cut enough that you could file leave with HR and simply notify your boss and colleagues that you will be OOO for most or all of the next 2 months and have them think nothing of it and not speculate and everything will be fine, but I don't think that's going to be totally true for a lot of people. I feel like a courtesy conversation with your boss either before or after HR notifies him would be beneficial, but you can still go into that conversation saying simply that it's sensitive and personal and you're sorry for the disruption, you're going to provide XYZ documentation or hand-off to a designated substitute or whatever other planning needs to happen while you're out.

Your boss is going to assume you're going to rehab, and that may be part of what is driving your thoughts of working partial days or whatever, but like the others I would urge you to at least take the first 3-4 weeks completely off if you can. For one thing, it may make your leave way more straightforward than trying to make intermittent leave work. But if you feel like it would be better and you know from the program schedule that you will always have X day off, you could discuss with your boss whether it is helpful or productive for you to make yourself available maybe half of that day each week for people to grab you for questions or whatever. The answer to that might be no, though; it might be less disruptive to just expect you to be out-out for the duration.

As far as the impostor syndrome, you should expect any good program to tackle that from pretty early on, and there may even be some communication rules that's meant to de-hierarchize everyone's personal trauma narratives. In fact, you are likely to be in the program with people whose trauma originated in adulthood and involved personal choices they were able to make, two things that are not true for you and you may very well have your own (private, addressed in individual sessions with a counselor) moments of "how dare". But you're also going to have moments where you and another person whose traumas are vastly different from your own are living with eerily similar aftermaths, coping mechanisms, symptoms, etc because that's what you're actually in treatment for. You will likely find enough in common with your group that the differences don't matter so much.
posted by Lyn Never at 11:52 AM on July 15

The book titled C-PTSD: from surviving to thriving (which I HIGHLY recommend as it is both insightful and very actionable) says that minimizing your trauma is actually one of the key symptoms of C-PTSD ❤️
posted by missjenny at 1:14 PM on July 15 [4 favorites]

Anon, if you're in the US, I want to completely back up muddgirl's comment that you get FMLA for this. You don't have to take an entire chunk of time off to use FMLA. It sounds like this would qualify, and you don't have to disclose everything to HR to get it. Even in a supportive workplace, FMLA protects you. It's a great idea.
posted by bluedaisy at 2:47 PM on July 15

In college, I had a choice of sorts. I could either acknowledge my (major) depression and adjust my life accordingly, taking a lighter courseload and aiming for low-stress employment after I graduated. Or, given my grades, I could easily barrel on to a demanding career mostly through willpower and adrenaline. If there was a middle way, I didn't see it (and honestly the first course of action would have been perfectly acceptable).

I barreled, sticking myself into fulltime office jobs that hurt me, and choosing high stress career options (law anyone) that did the same. While law didn't last very long for me, the software development-adjacent careers I chose afterward were hardly low-stress, especially with frequent workplace hostility toward underrepresented people.

I was also autistic, but I didn't know that at the time. I'm not sure it would have changed anything, though. What's important to note is that I forced myself into decades of "heroic attempts to appear normal" when I was disabled. It cost me greatly: I did not have enough energy to work fulltime AND to build a satisfying life outside of work. I finally had to retire and now I lead a very isolated life with limited capacity to pursue the activities I love.

Whether or not you've chosen your field with more consideration than I did, I reiterate that working in an abled world while disabled means that tradeoffs will be necessary and you may have to forego higher pay / greater work responsibility.

The socioeconomic laurels that come to people who aren't disabled are in fact achievable by disabled people - but at what cost to those people?
posted by Sheydem-tants at 3:51 AM on July 16 [4 favorites]

The one thing if you're doubting the seriousness of your trauma: Try balancing on one leg with your eyes closed for a minute.

I know, I know BUT struggling with balance, being unable to physically sense your body, that's trauma. The damage from trauma isn't just some abstract mental health thing, it's in your body.

For me, realising this and starting to physically feel the amount of fear I'd been storing in my body but ignoring for so long, made my own trauma so much realer and harder to deny. I'm not broken, I just don't want to feel my body because I had to shut it down as a child, and now it's full of spiders. But it's also always there.

It sounds like you're approaching this as a mental problem with intellectual solutions (which, us ADHDers love to do hahaha) and there's nothing wrong with that. Just I would recommend checking out Body Keeps the Score if you haven't already. Also ADHD 2.0 has some woolliness, but also nice practical suggestions in there on befriending your body.

And - I would try and take the full-time off if you can, and without saying why.. You also want to be doing this for you and yourself, you don't want the sly 'what if they're expecting me back and healed' thought, especially if you're used to prioritising others' emotions above your own. DM if wanna chat!
posted by litleozy at 6:43 AM on July 19

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