There are those who think I have taken an anti homosexual stance. So let me clarify. I have no “stance” about homosexuality. I only try to follow the science and not shy away from facts that are politically incorrect. That helps no one, especially those who want to change.
Can we cure it? Wait! Is it an illness, a deviation that needs curing? If you ask anyone whose defenses work and have always worked they would say, “Why would I need curing? And since I am not in the priesthood (most of all being Jewish) I don’t have any desire to cure anyone of anything if they don’t want and need it. But I do want to help those who suffer. Some suffer from being gay and others are very comfortable with it. Why would I or anyone want to treat them? I have no mission and never have had a mission to save the world. I have found a way, to me the scientific way, to help those who hurt, who are anxious and depressed, who can’t function and who are miserable. We don’t advertise and make outrageous claims about homosexuality or anything else. We have “cured” some homosexuality. We didn’t start out to cure anything but two or three of them came to me after some time in therapy and said, “My orientation has changed.” I said fine. If it makes them happy so much the better.
What causes it? That is a sticky wicket. I have the feeling that with all the new research there is a hormonal base to some of it since traumas in the womb can and do change the later sex hormone levels. That is not all. There has to be a familial configuration that deprives the child of fulfillment of need, somehow, somewhere. I do think heterosexuality is normal, given the need for survival of the species, to say nothing of how the parts fit together to make babies. I really don’t care if homosexuals think they are normal. That is their choice. I do not agree or disagree. I try to follow my experience for over fifty years of therapy and of all the new research, including brain changes in homosexuals.
There seems to be general agreement in late research that traumas while in the womb can predispose to homosexuality. This is certainly true in animals where females show mounting behavior. Yes, there are many animals who show homosexuality. I am sure and do not dispute that. But I am an expert in humans, not homosexuality. I don’t know who is. I have no spin whatsoever about this anymore than I know that gestation and birth trauma lead to migraines later on. If a migraine lobby tells me I am dead wrong, I can only indicate my experience over many decades with it. And since we have cured many migrainers I will stick to my story. Incidentally, my new book (manuscript) cites many of the studies I mentioned above. Let’s get off the posturing. If I can help those with epilepsy, migraine and high blood pressure there must be something to the theory. I do not know of any other psychotherapy that helps epilepsy nor deep depression. That is because they cannot go deep enough to make profound changes. What this means is that the causes and origins of many afflictions lie very deep in the brain. Therefore all therapies that use words to help people are talking to the wrong brain.
About being prejudiced. Members of my staff have been gay. I engage those who are competent, period. When I am in doubt about something I check with my homosexual friends. When I want to know more about high blood pressure I check with my patients. I do not have to be the repository of all wisdom.
Saturday, May 23, 2009
Sunday, May 17, 2009
On Psychosis
Is psychosis a different malady from neurosis? Is it treatable? Curable? What causes it? Heredity? Epigenetics or just plain bad experience?
I wrote this recently about how we manufacture inhibitory/repressive chemicals such as serotonin.
“What is very important for us to realize was that a mouse fetus does not make her own serotonin until the third trimester. It seems like the mother supplies what is needed until the baby can take over. But when the mother is low on supplies, she cannot fulfill what the developing baby lacks. Therefore, the baby carries around a load of pain. Now if we apply that to humans, there seems to be a time in gestation when pain or noxious stimuli impinge, but we are not yet able to produce our own gating chemicals—ungated pain. This residue will continue and may lead to bouts of anxiety later on in life. It becomes free-floating fear or terror. This is not due to heredity but rather to experience in the womb. This is why we should never neglect womb-life when addressing neurosis.
Part of our in utero life, therefore, takes on hurt at a time when our system can do nothing about it. Nevertheless, it affects all later development. At thirty we may suffer from panic attacks that began its life in the very early months of our mother’s pregnancy. It is pristine and free-floating, ready to spring forth whenever we are vulnerable. No talk therapy can make a dent in it. It leaves us fragile for a lifetime so that any insult in infancy and childhood weakens us all the more.
It seems to me that there may be a genetic component to psychosis but equally if not more important is epigenetics; what happened very early on in gestation. My guess is that the earlier the trauma (mother smoking, drinking, high anxiety state or depression) the more we have the makings for psychosis. For the reasons cited above; the fetus takes on hurt before he can do anything about it. Worse, this alteration in the first months of gestation alters the set-points permanently so that the person is forever low in inhibition or repression. Of course, as an adult he will need the very chemicals he lacked in the womb; inter alia serotonin. And the heavy duty drugs we use on psychotics are enhancers of serotonin. Why? Because early trauma depressed its output and made the body think that was normal. Of course the body doesn’t think in words, but it does in chemicals. And that communication begins with the advent of the secretion of key chemicals while in the womb. It is just an accident that effective pills simply make up for what is missing in the person’s system? What pills do is supply the missing link, help out our physiology and try, therefore, to reestablish normality. So sometimes the mentally ill feels normal again. That is no surprise since we are artificially normalizing the person’s physiology. In Primal Therapy we normalize in the normal way; that is, we reestablish setpoints. That is why after one year of our therapy there are normal levels of serotonin.
What is the hallmark of psychosis? Usually it is hallucinations and delusions. Delusions are a later development than hallucinations. They indicate a more organized cerebral/thinking apparatus. But both manifestations are provoked by upsurging very, very early pain; usually there is no content to this pain other than pure agony.
Can they be treated? We have done so with some success but in-house therapy is needed. Otherwise there is too much stress out there for the mentally ill to adapt. There is evidence that when the psychotic hears voices there is an activation of the brain system where those voices originate. For delusions; there is usually the notion that someone “out there” is out to hurt him. The pain/hurt is already inside, and it is now rationalize as being out there. But the brain is reacting to the hurt. Since the person has no idea where that hurt comes from and how early it occurred, he has no choice but to project it out there: “They are plotting to hurt me.”
There are many ways to go crazy. The body does it with cancer, a cellular out-of-control event. The brain does it with ideas, but it is always the same pain they are dealing with. Psychosis merely means that the normal defense mechanisms do not work. The brain is stretched into wild and unreal ideas because there is no other way to get a handle on the pain. As we add pain killers to the psychotic the delusions lessen. Clearly, they are associated with pain. The great question is where does it come from? I think I know, but we will let research help out here.
I wrote this recently about how we manufacture inhibitory/repressive chemicals such as serotonin.
“What is very important for us to realize was that a mouse fetus does not make her own serotonin until the third trimester. It seems like the mother supplies what is needed until the baby can take over. But when the mother is low on supplies, she cannot fulfill what the developing baby lacks. Therefore, the baby carries around a load of pain. Now if we apply that to humans, there seems to be a time in gestation when pain or noxious stimuli impinge, but we are not yet able to produce our own gating chemicals—ungated pain. This residue will continue and may lead to bouts of anxiety later on in life. It becomes free-floating fear or terror. This is not due to heredity but rather to experience in the womb. This is why we should never neglect womb-life when addressing neurosis.
Part of our in utero life, therefore, takes on hurt at a time when our system can do nothing about it. Nevertheless, it affects all later development. At thirty we may suffer from panic attacks that began its life in the very early months of our mother’s pregnancy. It is pristine and free-floating, ready to spring forth whenever we are vulnerable. No talk therapy can make a dent in it. It leaves us fragile for a lifetime so that any insult in infancy and childhood weakens us all the more.
It seems to me that there may be a genetic component to psychosis but equally if not more important is epigenetics; what happened very early on in gestation. My guess is that the earlier the trauma (mother smoking, drinking, high anxiety state or depression) the more we have the makings for psychosis. For the reasons cited above; the fetus takes on hurt before he can do anything about it. Worse, this alteration in the first months of gestation alters the set-points permanently so that the person is forever low in inhibition or repression. Of course, as an adult he will need the very chemicals he lacked in the womb; inter alia serotonin. And the heavy duty drugs we use on psychotics are enhancers of serotonin. Why? Because early trauma depressed its output and made the body think that was normal. Of course the body doesn’t think in words, but it does in chemicals. And that communication begins with the advent of the secretion of key chemicals while in the womb. It is just an accident that effective pills simply make up for what is missing in the person’s system? What pills do is supply the missing link, help out our physiology and try, therefore, to reestablish normality. So sometimes the mentally ill feels normal again. That is no surprise since we are artificially normalizing the person’s physiology. In Primal Therapy we normalize in the normal way; that is, we reestablish setpoints. That is why after one year of our therapy there are normal levels of serotonin.
What is the hallmark of psychosis? Usually it is hallucinations and delusions. Delusions are a later development than hallucinations. They indicate a more organized cerebral/thinking apparatus. But both manifestations are provoked by upsurging very, very early pain; usually there is no content to this pain other than pure agony.
Can they be treated? We have done so with some success but in-house therapy is needed. Otherwise there is too much stress out there for the mentally ill to adapt. There is evidence that when the psychotic hears voices there is an activation of the brain system where those voices originate. For delusions; there is usually the notion that someone “out there” is out to hurt him. The pain/hurt is already inside, and it is now rationalize as being out there. But the brain is reacting to the hurt. Since the person has no idea where that hurt comes from and how early it occurred, he has no choice but to project it out there: “They are plotting to hurt me.”
There are many ways to go crazy. The body does it with cancer, a cellular out-of-control event. The brain does it with ideas, but it is always the same pain they are dealing with. Psychosis merely means that the normal defense mechanisms do not work. The brain is stretched into wild and unreal ideas because there is no other way to get a handle on the pain. As we add pain killers to the psychotic the delusions lessen. Clearly, they are associated with pain. The great question is where does it come from? I think I know, but we will let research help out here.
Sunday, May 10, 2009
How to Relive Trauma that Happened during Life in the Womb
I have been writing about the long-term effects of our experience while in the womb. Another question arises immediately on the heels of that question. How on earth can anyone relive those events—a mother’s depression or anxiety, her drug and alcohol use, poor diet and lack of proper physical care by the mother?
We need to go back to our evolutionary roots and note that as the brain develops, each new structure or area incorporates and re-represents events imprinted on lower brain levels. Thus, there are spokes radiating out of our primitive nervous system that travel all the way to the neocortex (new cortex) via limbic structures to inform the higher levels of what happened on the lower brain levels, even while we lived our life in the womb. So when we feel helpless in the present—no one can process our application until we fulfill impossible requirements—we can begin to experience that feeling now, which will then take us back via the vehicle of feeling to the origins of that feeling. Once we are locked into that feeling the brain takes charge and we have to make no deliberate effort to go back into our past. We feel helpless in the present but it is not a “normal” feeling; it carries with it the force of the beginnings of the feeling when it might have been a matter of life and death. We seemingly over-react but we are reacting, as well, to our history, which has embedded itself into the feeling. When we relive that feeling completely we have automatically relived earlier origins of the feeling; and we can be liberated from its deleterious effects without once acknowledging what the feeling was all about.
But we must eschew verbal explanations or understanding because the body is speaking an entirely different language. And when high blood pressure or migraine normalizes itself without any voluntary act after reliving that helpless feeling, we can assume that we dipped into ancient origins of the feeling and have resolved aspects of the imprint itself. Although I have observed this kind of reliving resulting in the resolution of serious symptoms, it is not enough because it is considered anecdotal and unworthy of science. Lately, however, there is a plethora of research to bolster the point. K.J.S. Anand is one of the premier investigators of this research. (“Can Adverse Neonatal Experiences Alter Brain Development and Subsequent Behavior?” Biology of the Neonate, 2000: 77. 69-82).
He and his associates have produced a compendium of many research studies on the subject. He begins: It is “suggested that imprinting at birth may predispose individuals to certain patterns of behavior that remain masked throughout most of adult life but may be triggered during conditions of extreme stress.” (page 70) This seems like a direct quote from some of my writings. The reason they are similar is because we are describing the same event, they from a scientific research point of view, and I from a clinical observational post.
Anand observes: “for suicides committed by violent means (firearms, jumping in front of a train, hanging, strangulation, etc) the significant risk factors were those perinatal (around birth) events that were likely to cause pain in the newborn.” (same page) Harmful factors included forceps delivery and other neonatal complications that were significantly correlated with adult suicide attempts. Lack of care just after birth also was heavily correlated with later suicides, especially adolescent suicide attempts. Sedatives and/or drugs given to the mother during delivery was noted to increase the later problem of drug addiction. Karen Nyberg also found that drugs the mother took during pregnancy or at birth led to a greater tendency to drug addiction as adults. In short, experience in the womb has, as we have noted for decades, enduring effects. If we want to know the whys of certain behaviors such as suicidal tendencies or drug abuse, we need to go way back into our remote history to find the answers. What Anand points out is we need to study in humans the long-term changes in the brain from traumas in-utero. We know, for example, that certain kinds of cells (NMDA receptors) are permanently altered as a result of lowered oxygen the womb and during birth. This is particularly true because the prenatal and neonatal periods are marked by very rapid brain growth.
I have written extensively about critical periods; those times in life when irreversible changes occur that we cannot change no matter how hard we try. I no longer think that the major critical period is in infancy; rather, it seems like irreversible changes are most apt to occur during our life in the womb; and secondarily around birth, when we have peak brain growth. It is here that the neuronal circuitry can be altered forevermore. In any number experiments with animals, those who were delivered pain just after birth or who were deprived of a mother’s care just after birth had a greater tendency to drink alcohol. In other words, very early pain persists as an imprint and leads to all manner of deviate behavior. Clearly, for any therapy to be successful we need to address those early imprints; those origins of the deviation.
We need to go back to our evolutionary roots and note that as the brain develops, each new structure or area incorporates and re-represents events imprinted on lower brain levels. Thus, there are spokes radiating out of our primitive nervous system that travel all the way to the neocortex (new cortex) via limbic structures to inform the higher levels of what happened on the lower brain levels, even while we lived our life in the womb. So when we feel helpless in the present—no one can process our application until we fulfill impossible requirements—we can begin to experience that feeling now, which will then take us back via the vehicle of feeling to the origins of that feeling. Once we are locked into that feeling the brain takes charge and we have to make no deliberate effort to go back into our past. We feel helpless in the present but it is not a “normal” feeling; it carries with it the force of the beginnings of the feeling when it might have been a matter of life and death. We seemingly over-react but we are reacting, as well, to our history, which has embedded itself into the feeling. When we relive that feeling completely we have automatically relived earlier origins of the feeling; and we can be liberated from its deleterious effects without once acknowledging what the feeling was all about.
But we must eschew verbal explanations or understanding because the body is speaking an entirely different language. And when high blood pressure or migraine normalizes itself without any voluntary act after reliving that helpless feeling, we can assume that we dipped into ancient origins of the feeling and have resolved aspects of the imprint itself. Although I have observed this kind of reliving resulting in the resolution of serious symptoms, it is not enough because it is considered anecdotal and unworthy of science. Lately, however, there is a plethora of research to bolster the point. K.J.S. Anand is one of the premier investigators of this research. (“Can Adverse Neonatal Experiences Alter Brain Development and Subsequent Behavior?” Biology of the Neonate, 2000: 77. 69-82).
He and his associates have produced a compendium of many research studies on the subject. He begins: It is “suggested that imprinting at birth may predispose individuals to certain patterns of behavior that remain masked throughout most of adult life but may be triggered during conditions of extreme stress.” (page 70) This seems like a direct quote from some of my writings. The reason they are similar is because we are describing the same event, they from a scientific research point of view, and I from a clinical observational post.
Anand observes: “for suicides committed by violent means (firearms, jumping in front of a train, hanging, strangulation, etc) the significant risk factors were those perinatal (around birth) events that were likely to cause pain in the newborn.” (same page) Harmful factors included forceps delivery and other neonatal complications that were significantly correlated with adult suicide attempts. Lack of care just after birth also was heavily correlated with later suicides, especially adolescent suicide attempts. Sedatives and/or drugs given to the mother during delivery was noted to increase the later problem of drug addiction. Karen Nyberg also found that drugs the mother took during pregnancy or at birth led to a greater tendency to drug addiction as adults. In short, experience in the womb has, as we have noted for decades, enduring effects. If we want to know the whys of certain behaviors such as suicidal tendencies or drug abuse, we need to go way back into our remote history to find the answers. What Anand points out is we need to study in humans the long-term changes in the brain from traumas in-utero. We know, for example, that certain kinds of cells (NMDA receptors) are permanently altered as a result of lowered oxygen the womb and during birth. This is particularly true because the prenatal and neonatal periods are marked by very rapid brain growth.
I have written extensively about critical periods; those times in life when irreversible changes occur that we cannot change no matter how hard we try. I no longer think that the major critical period is in infancy; rather, it seems like irreversible changes are most apt to occur during our life in the womb; and secondarily around birth, when we have peak brain growth. It is here that the neuronal circuitry can be altered forevermore. In any number experiments with animals, those who were delivered pain just after birth or who were deprived of a mother’s care just after birth had a greater tendency to drink alcohol. In other words, very early pain persists as an imprint and leads to all manner of deviate behavior. Clearly, for any therapy to be successful we need to address those early imprints; those origins of the deviation.
Sunday, May 3, 2009
More on Life Before Birth
If you have trouble in your emotional life you need to examine your life before birth. When the whole system is gearing up for life on the planet, gestational life has already constructed a crucible for life outside the womb. Life in the womb is perhaps the most important time of our lives; so much of adult symptoms and behavior can be traced to that epoch.
I have written about the prototype, the “Now print” that is engraved in the neurophysiologic system even before birth. Any severe trauma while the mother is carrying can be imprinted into the baby's system where it may well remain for the rest of his life. Here it may change the brain circuits and cause a permanent deviation in the function of organ systems. There is much less possibility of that after birth. It is “now print” because it is setting down a prototype of heuristic value that will direct behavior thereafter. It is memory of survival, of what worked before to save our lives. And it worked when the input stimulus may have been a life-and-death matter as so many traumas during womb-life are. This will happen despite the fact that there is no functioning neo-cortex to remember the scene; it happens below the level of conscious/awareness, which is why we cannot get there through the vehicle of language. Here we have a learning system that is distinct from the verbal learning/memory system that we will develop later. It is neurophysiologic memory.
Now what does the prototype do? It folds all that surrounds a feeling/memory and distills it into a general principle. When confronted with an obstacle, for example, it is best to retreat, not meet it head on (the choice of the parasympath, passive individual where passivity was life saving in the womb). The principle is not struggling for air when the mother is anesthetized at birth, but retreating into less use of energy and oxygen—passivity. To undo that imprint, not so easily done, we need to return to the brain that registered it and relive it. If someone says that the patient must then be offered a new ending for what he relived, we understand immediately that we have enlisted the aid of the adult brain and undercut what the patient has felt during the session.
We know that in reliving gestational life or the birth trauma we are succumbing to deep and long, slow-wave, brain signatures which denotes life before birth. To then appeal to the late developing new-comer, the neo-cortex, to finish off the sequence and add a good ending confounds the work of the deep unconscious. Essentially it takes the patient out of the deep brain imprint and places her back to the neocortex. The same can be said for early childhood pain where the brain that should be employed, the right feeling side, is abdicated for the left brain explanatory, understanding one. In short, we continue to talk to the wrong brain.
A patient with a very rapid, left frontal cortical signature cannot be feeling until we bring her into the feeling zone. The frontal thinking apparatus must recede for a time. And again, language only plays a secondary role. One way we do that is offer tranquilizers to the patient for a short period of time to push down some inordinate pain from gestation or birth. The overload of pain and all levels prevents one from integrating feeling by feeling. We must remember that in dealing with very early life we are mostly describing the work of the right brain. The left brain focus will not get us there. Yet after a year of therapy it will help to also use the left brain for understanding so that each side is more in equilibrium with the other—a more harmonious brain.
To offer patients an understanding of his motivation by the therapist or to propose a different ending of the pain by a therapist means an appeal to the wrong brain. It negates the whole notion of the critical window, where there is a time to fulfill need and only that time. So to utilize the more advanced, later evolved brain cannot allow for integration. The only way to resolve the earlier trauma is put yourself back there (or to be lead there by a therapist) neuro-physiologically and resolve on that level.
Integration means that reliving memory will affect nearly every system in our lives. So we measure natural killer cells, serotonin and brainwave function to test whether there has been integration; and we have found profound changes in all of those over time in our therapy. So we ask, “does it matter if we don’t relive events during womb life? Yes, because that reliving can produce a change in many physiologic parameters and in behavior. So the answer is clear. Yes, it matters because we have seen engraved patterns (migraine, high blood pressure, impulsive acting-out)from early childhood on that get resolved and integrated decades later in therapy. If patients needed to do more than relive, then they would feel worse, not better, months and years after therapy. And their physiologic changes would not hold up.(The stress hormone, cortisol, would again diminish to pre-therapy times). I think the only time we can rewire deviated set-points is when the brain retreats to an earlier prenatal time and deals directly with the original causes of deviation.
To imagine that some kind of explanation by the therapist to what a patient has relived will help, is to forget about the critical window, as I have mentioned. We have to be on that level to integrate; it cannot be done from “above.”(the neocortex). It cannot be the adult watchng the child go through it all. It must go from the bottom to the top in the order of evolution. In so doing we are back in the trauma, completely, feeling each component of the event and putting it back together in a new way. Here is cohesion and resolution.
I have written about the prototype, the “Now print” that is engraved in the neurophysiologic system even before birth. Any severe trauma while the mother is carrying can be imprinted into the baby's system where it may well remain for the rest of his life. Here it may change the brain circuits and cause a permanent deviation in the function of organ systems. There is much less possibility of that after birth. It is “now print” because it is setting down a prototype of heuristic value that will direct behavior thereafter. It is memory of survival, of what worked before to save our lives. And it worked when the input stimulus may have been a life-and-death matter as so many traumas during womb-life are. This will happen despite the fact that there is no functioning neo-cortex to remember the scene; it happens below the level of conscious/awareness, which is why we cannot get there through the vehicle of language. Here we have a learning system that is distinct from the verbal learning/memory system that we will develop later. It is neurophysiologic memory.
Now what does the prototype do? It folds all that surrounds a feeling/memory and distills it into a general principle. When confronted with an obstacle, for example, it is best to retreat, not meet it head on (the choice of the parasympath, passive individual where passivity was life saving in the womb). The principle is not struggling for air when the mother is anesthetized at birth, but retreating into less use of energy and oxygen—passivity. To undo that imprint, not so easily done, we need to return to the brain that registered it and relive it. If someone says that the patient must then be offered a new ending for what he relived, we understand immediately that we have enlisted the aid of the adult brain and undercut what the patient has felt during the session.
We know that in reliving gestational life or the birth trauma we are succumbing to deep and long, slow-wave, brain signatures which denotes life before birth. To then appeal to the late developing new-comer, the neo-cortex, to finish off the sequence and add a good ending confounds the work of the deep unconscious. Essentially it takes the patient out of the deep brain imprint and places her back to the neocortex. The same can be said for early childhood pain where the brain that should be employed, the right feeling side, is abdicated for the left brain explanatory, understanding one. In short, we continue to talk to the wrong brain.
A patient with a very rapid, left frontal cortical signature cannot be feeling until we bring her into the feeling zone. The frontal thinking apparatus must recede for a time. And again, language only plays a secondary role. One way we do that is offer tranquilizers to the patient for a short period of time to push down some inordinate pain from gestation or birth. The overload of pain and all levels prevents one from integrating feeling by feeling. We must remember that in dealing with very early life we are mostly describing the work of the right brain. The left brain focus will not get us there. Yet after a year of therapy it will help to also use the left brain for understanding so that each side is more in equilibrium with the other—a more harmonious brain.
To offer patients an understanding of his motivation by the therapist or to propose a different ending of the pain by a therapist means an appeal to the wrong brain. It negates the whole notion of the critical window, where there is a time to fulfill need and only that time. So to utilize the more advanced, later evolved brain cannot allow for integration. The only way to resolve the earlier trauma is put yourself back there (or to be lead there by a therapist) neuro-physiologically and resolve on that level.
Integration means that reliving memory will affect nearly every system in our lives. So we measure natural killer cells, serotonin and brainwave function to test whether there has been integration; and we have found profound changes in all of those over time in our therapy. So we ask, “does it matter if we don’t relive events during womb life? Yes, because that reliving can produce a change in many physiologic parameters and in behavior. So the answer is clear. Yes, it matters because we have seen engraved patterns (migraine, high blood pressure, impulsive acting-out)from early childhood on that get resolved and integrated decades later in therapy. If patients needed to do more than relive, then they would feel worse, not better, months and years after therapy. And their physiologic changes would not hold up.(The stress hormone, cortisol, would again diminish to pre-therapy times). I think the only time we can rewire deviated set-points is when the brain retreats to an earlier prenatal time and deals directly with the original causes of deviation.
To imagine that some kind of explanation by the therapist to what a patient has relived will help, is to forget about the critical window, as I have mentioned. We have to be on that level to integrate; it cannot be done from “above.”(the neocortex). It cannot be the adult watchng the child go through it all. It must go from the bottom to the top in the order of evolution. In so doing we are back in the trauma, completely, feeling each component of the event and putting it back together in a new way. Here is cohesion and resolution.
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