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PTSD Questions & Answers
with
Joyce Boaz & Dr. Frank Ochberg, M.D.

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Relationships: Toxic Family of Origin.

Q: Dear Frank:

I've heard you use the phrase "toxic family." What does that
mean and what can one do about it?

A: Dear Joyce:

There are times when a survivor is obligated to attend a
family function and does so with a feeling of dread. Usually, the
emotion includes a prophetic sense that there will be an insult or an
argument and the survivor will become humiliated or enraged. The
source of antagonism is often a parent or a sibling from the family of
origin. But the toxic nature of the family may be quite complicated
and all the variations are beyond simple description. From the
perspective of PTSD, the poison works in two ways. First, the
survivor is "triggered" or "stimulated." Second, the survivor is
"regressed" or "infantilized."

Most GFW visitors understand the term, "triggered." It means that a
sensitive part of the brain reacts to a person, place or idea with
something that is like a memory, but not necessarily a clear and
complete recollection. A survivor may have a sensation that is
disturbing and vaguely familiar--hard to place, alien, awkward and
tinged with fear. Or there could be an all-too-evident re-experiencing
of a terrible time. In a family setting, the memory may be of a
parent who should have known but was unaware of abuse by the other
parent. Or of a sister who refused to acknowledge reality and blamed
the victim. PTSD always includes this vulnerability to "triggers." It
is part of the definition of the condition. Recently, I visited a
brilliant team of research scientists in Minneapolis who have located
an area of the brain (right temporal lobe) that behaves in a subtly
different way during electrical measurement of PTSD survivors, in
contrast to non-traumatized controls. More work needs to be done to
nail down this finding, but I'm convinced that they are on track to
locate the "brain injury" of PTSD. If you have that "brain injury" it
means that you are easily triggered, and when triggered, you have
sensations or memories from the past that cause distress.

Simply having a bad sensation is tolerable if you remain secure in
your mature, adult "self." But the toxic family doesn't allow you to
stay mature and adult. There is something about the way these
families interact that protects the perpetrator and blames the
victim. Adult survivors who return, after a healing period of
absence, usually find themselves treated like a child or an infant.
They cannot assert themselves effectively. I have thought of these
families, or of individual family members, as "kryptonite." They are
elements from a past life that rob one of his or her powers and make a
survivor weak and vulnerable. In the case of a soldier returning from
war, the "kryptonite" works in different, but related, way. A 30 year
old may be treated like a 16 year old. There is either too much or
too little interest in hearing about life and death among comrades-in-
arms. The veteran wishes that civilian family life can be restored,
but has little tolerance for those who can't appreciate the reality of
war. And to be treated as an adolescent ironically elicits adolescent
emotion: rage and rejection.

The kindest of families may have a hard time assimilating one who has
been "to hell and back." Toxic families add insult to injury and are
often clueless and remorseless.

So why try to maintain loyalty to a toxic family? I often wonder
why. There are times when I advise a survivor to forgo a family
holiday or to avoid contact with a demeaning, demoralizing relative.
You don't HAVE to go home again. PTSD means that the past pursues
you. Successful treatment entails escaping from a relentless past.
Since adults with PTSD have competing responsibilities, I almost
always reinforce a survivor's responsibility to current concerns: job,
new family, health and self, before obligations to past family
members. There are times when a doctor writes a medical excuse from
work. I can't exactly write a medical excuse from attendance at a
family reunion, but I wish I could. The next best thing is to work on
the "Board of Directors," the voices of authority from a survivor's
past that yap away in one's mind, creating guilt and doubt for
avoiding the toxic family.

Often a survivor cannot avoid a family encounter. The common-sense
advice for minimizing damage, in the form of triggers and regression,
is to rehearse with a trusted person (or a therapist), practicing
responses to provocative comments; to limit exposure; to include
trustworthy family members during encounters with those most likely
to press sensitive buttons; and to work diligently to master
relaxation techniques and methods to preserve self-esteem. Good PTSD
therapy includes those topics.

There are family therapists and dynamic therapists who specialize in
improving one's ability to overcome entrenched patterns that began in
the family of origin. Some PTSD specialists also are masters at these
approaches. But most survivors will do best by recognizing that the
"toxic family" exists and you cannot be blamed for your choice of
parents and sibs. You can do your best to give and receive love and
respect. But it may be impossible to achieve a healthy relationship
with certain relatives, and you have a right to chose your own path.
You are among many friends, peers and support pals, when you decide to
"do it your way." Protect your adult self. Be responsible to your
current significant others. Limit your exposure to the unfortunate but
common "kryptonite" from the past.

Relationships: Toxic Family of Origin.

Q: Dear Frank:

Several GFW pen pals write about very upsetting visits with family members on holidays or on obligated trips to visit sick or aging relatives. Any words of wisdom on this situation?

A: Dear Joyce:

The "toxic family of origin" is well known to me as a therapist. We select our friends, but not our relatives and some relatives have a knack for opening old wounds. I find this particularly true of older sisters of my female survivor patients. I don't intend to extend this observation to all older sisters or even to most. But there is a pattern affecting some, and it may have a lot to do with secrets. Most of my patients are survivors of trauma. If they come from healthy, loving families, they have a foundation of self-esteem that helps them cope with adversity, and they have empathic relatives to provide support when stress arises. But the "toxic family" is typically one in which individuals have been emotionally abused AND neglected. The abuse may be as profound as incest or as common as teasing. The neglect may be icy indifference or distance due to parental ill-health and overwork. Sibs learn to cope for themselves. Older sibs may try to protect younger ones from an abusive parent, but deny the struggles that they, themselves have had. A big sister may identify with the aggressor, becoming the "kapo" of the camp - the one who carries out a sadistic policy of a punitive parent.

Regardless of the details, this means that my patient suffered as a child, and an older sib made her feel worse. When this leads to complete alienation with no meaningful contact, the problem is not so problematic. But most of my patients have a longing for an ideal family. They visit when expected to "come home" although the family of origin is no longer the place called home. And when they visit (or even when they call on the phone) there is a terrible sense of oppression. My patient feels assaulted, belittled, isolated and helpless. She may be able to express her feelings, but she cannot win the support of her sister. Her sister may have suffered similar abuse and neglect growing up, but her defense was to pretend it didn't happen. She may have a form of survivor guilt, having weathered storms herself, but failing to protect a younger sib. She may be jealous of a younger sib who managed to escape the family while she, the big sister, remained.

At any rate, all this unfolds through the years without truthful conversation. Roles become fixed. Family members play their parts. These parts become caricatures-- exaggerated archetypes. The Cinderella story is an example of that exaggerated scenario. Reality seldom provides a fairy-tale ending, so the question, "How do I cope with my toxic family?" needs a more practical answer.

If you are one who struggles with painful contacts with toxic relatives, consider these suggestions:

1. Don't visit. You have a right to protect your sanity, self-esteem, and mental health. Although the pressure may be enormous and a parent or sib may be extremely critical, you can stand up for yourself and say, "No." There are many who have taken this course and they eventually feel better, with more self-esteem and more reserves of good feelings for their own children, partners, and friends.

2. Keep visits short and superficial. This is really a variant of #1 and it requires a deliberate plan to avoid exposure to old issues and old wounds. It is perilous, since the expression on a sister's face may be enough to cause an upheaval in the gut and sense of dread throughout the body. These are reflexes from times of helpless immaturity. They are very unpleasant. So limit your exposure and dose.

In the case of #1 and #2 you may need a ready explanation. Nothing will work perfectly. Some possibilities are, "My doctor told me to avoid certain situations that trigger my stress. I have discussed this and am doing it for medical reasons." Another, especially for suggestion #2 is, "Let's just keep it light." --then change the subject.

3. Bring a cell phone and be sure to have contact with a dependable friend during a family visit. For GFW support pals, this may already be occurring. Those conversations can be relatively brief. They shouldn't "stir the pot" with details of demeaning behavior. Some venting could be good. The main idea is to have a "lifeline" during the visit, serving as a source of oxygen when the air is thin, reminding you that you have friends who understand and have endured similar stressors.

4. Practice everything you have learned about stress management, enhancement of self-esteem, and recognition of reality. By recognition of reality, I mean saying to yourself, "This is now, not back then when I was a child. I have my own home and friends. This visit may be stirring feelings from the past, but I need not live in the past." You might even carry a list of what you admire about yourself, and review it during the visit. It is not to be shared with the toxic family. It is just for you.

5. Family therapy or therapy about your family of origin is always an option. But let's face it. The pattern is usually well established by the time one faces this situation in adulthood. Although I have some direct experience as a therapist with toxic families, it seldom works well. What does work well is counseling about strategies to manage specific events, like weddings and funerals - when to arrive, where to stay, whom to bring along.

In sum, the "toxic family" was dysfunctional to begin with and is a source of profound stress during every visit decades later. We have obligations to our families and may choose to "pay our respects" although those payments come with great emotional pain. There are no hard and fast rules that can be applied to all relatives and all survivors. But GFW does provide links, pals, ideas and resources. This Q & A is meant primarily to validate your reality and your self-worth if you come from a toxic family, if you choose to maintain contact, and if you suffer the inevitable emotional cost when you pay your dues to your clan.

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