The "False Positive" in Trauma Recovery: A Self-Defeating Adaptation of the Inner "Adolescent"

Be advised: This article contains depictions of physical, sexual, and emotional violence. It also contains descriptions of triangulated, unhealthy storytelling which a good human such as yourself might be unfairly using against your imperfect partner. The consumer should embrace this article with their triggers well in hand, and with an open mind. Names mentioned in this article belong to almagamated vignette characters.

The Boil-Down: Science students taking statistical analysis or research methodology classes are likely to encounter the statistical phenomena of "Type I and Type II errors." This article is designed to widen the field of vision for survivors whose nervous systems, dysregulated by the classical conditioning of historical abuse, neglect and abandonment, are throwing red flags for danger and severe narcissistic gravity when it's not actually present. The presence of "false positives" in trauma recovery (referred to as type I errors in statistics) signals an opportunity for upward growth and expansion.

The Details: Many of us have had a friend or family member who seems to repetitively make decisions which result in similarly bad outcomes. Mitch falls off the sobriety wagon for the fifth time after several months without alcohol, and ends up in detox. Letisha gets a good job she loves for the third time in eighteen months, but encounters predictable yet uncomfortable adversity and quits. Patrick once more falls in love with a guy just his type--a "bad boy"--only to be caught up once again in the relationship snare of intense but faithless love and domestic violence.

Patterns like this are common and natural in trauma recovery. In a given stage of healing, we are simply doing the best we can with what we were given by our upbringing. That's not going to be effective, of course; instead, it will produce equivalent or "isormorphic" results--harm that in some way resembles the harm we received in childhood and youth. Such inability to self-protect is described by Colin Ross as traumatic "re-enactment."  

As survivors grow weary of history repeating itself, they often become angry or otherwise empowered through traumatic promises containing passionate internal declarations that they will "never again" allow themselves to be harmed in historical ways. This developmentally natural self-empowerment is referred to as "undoing." Sometimes an "undoing" is infused with re-enactment, such as when a young sex trafficking survivor engages in promiscuity or self-employed prostitution ("I decide when, who, and how--and I keep the money"). Alternatively, it could be argued that a similar survivor who decides they will simply avoid sexual contact of any kind at any cost is more strictly engaging in "undoing."

This Eyes Wide Open blog article points out a shift that occurs in the trauma survivor's tactics, which is evidence of progress in recovery. This tactical shift fits into the language of the misinterpretation of scientific data, as I will articulate here. The University of Hawaii delineates the relationship between scientific "reality" and researcher hypothesis decisions using a confusion matrix distinguishing four outcomes:

• true positives (we concluded that dose "x" of acetaminophen lowered toddler fever, and statistical analysis supports that it did);

• false positives (we concluded that dose "x" of acetaminophen lowered toddler fever, but statistical analysis shows that it didn't);

• true negatives (we concluded that dose "x" of acetaminophen did not lower toddler fever, and statistical analysis supports that it didn't);

• and false negatives (we concluded that dose "x" of acetaminophen did not lower toddler fever, but statistical analysis shows that it did).

  
  

The article published on the Exploring Our Fluid Earth webpage is absent my confabulated acetaminophen examples used above. 

Jerzy Neyman and Egon Pearson published a landmark paper in 1933: "On the Problem of the Most Efficient Tests of Statistical Hypotheses" (in Philosophical Transactions of the Royal Society of London, Series A).  In that paper, the authors rigorously defined Type I errors (false positives) and Type II errors (false negatives). They also showed mathematically that for a given significance level, a researcher can choose a test statistic and "critical region" to minimize Type II errors.  This groundbreaking work was about reducing the chances of making mistakes when drawing scientific conclusions. I have included a graphic demonstrating the statistical distribution of Type I and Type II errors, and I welcome any correction or critique regarding what this graphic depicts.

This might be a good place in the conversation to point out that hard science and mathematics largely see knowledge through the philosophical lens of realism, which is focused on external truths--neglecting to account for the reality that every human scientist has an experientially programmed mind, a lens which refracts the way the scientist processes measurable external events.  Integrated Trauma Theory applies "hard science" such as brain physiology in much "softer" applications, preferring the lens of constructivism. The constructivist position is that there cannot be a reality independent of the observer. The interaction of recordable events, human experiences, internal stories, and shared social meaning create result in a human individual world view as unique as a fingerprint.

The trauma survivor's shift from Type II errors to Type I errors. Good trauma therapy is arguably designed to help the trauma survivor eliminate Type I errors and Type II errors in their lives; it's an important improvement during Phase III trauma treatment. In early recovery, the survivor of chronic trauma is more inclined to make Type II errors, which are false negatives. The ability to detect danger and the precursors to certain harm has never been sharp, or it is dulled by the apathy of low self-worth or an internal myth of doom. I am not referring to situations in which the survivor has never encountered the chance to escape the harm into which they were born (or adopted, or fostered, or sold); in those cases they can only choose the sanctuary trauma survival mechanisms of an immobilized, trapped child, such as "freezing" or "fawning." False negatives in this article include at least two mechanisms: 1) "reading the room" of a new environment they've encountered and consciously concluding they should enter and stay when it is immediately dangerous to do so or there is high risk of being victimized all over again by new perps; and 2) failure to consciously "read the room" at all due to apathy, dissociation, or other severe deficits in self-protection.

People from "good childhoods" do it too. The first mechanism listed above can originate from either of two family of origin situations. The child (often a pre-adolescent or adolescent, but sometimes a person in young adulthood) may be emerging from a family of origin where there was no major trauma, only subtle points of neglect due to parental structure which failed to prepare the child for the wiles of the world at large; these survivor individuals tend to describe "good" upbringings. In the second situation, the child survivor is entering or exploring the external world to escape a family of origin which visited one or more specific kinds of "Big T" trauma upon the child.

This second type of survivor a) escapes familiar harm only to find the same recognizable kind and degree of harm (or worse) in a new environment; b) escapes familiar harm to enter a new environment holding unfamiliar harm which they immediately recognize as at least equally traumatic but they see no way to escape the new harm; c) escapes the familiar harm of the family of origin only to settle for traumatic experiences of what they conclude is a lesser harm; or d) escapes familiar harm to a world of undetected unfamiliar harm, naively believing the new environment is not harming them.

So Andrea experiences escape "a," emancipating herself from the home where her mother beat her, only to enter a relationship where her boyfriend beats her. Emma experiences escape "b," in which she launches from the home where her father and brothers chronically raped her, only to enter a relationship in which her girlfriend constantly berates her and beats her up. In the next example, Benito leaves the neighborhood of his youth, where the man next door enticed him with comic books, locked him in the man's basement and sodomized him for a month--only to find employment as a young adult with an older man who pays him well but is sexually exploiting him. This situation could be an example of escape "c" or "d," depending on whether Benito recognizes the arrangement as harmful.

Early survivors self-protecting the only ways we know how. All of the examples above can be viewed as containing two kinds of early, triangulated (and therefore ineffective) trauma survival tactics: re-enactment and undoing. Being harmed by an older boy who performed oral sex on you, and then inviting another older boy to perform oral sex on you, is a re-enactment of the original harm; however, this kind of moving toward previous trauma is also an undoing, because you gained some control by initiating the contact in the second scenario. If I am tired of being punched out by my stepfather, grow big and strong enough to fight back and make him stop the abuse, then become an undefeated cage fighter who eventually develops CTE (Chronic Traumatic Encephalopathy), it's still a path of re-enactment, but the undoing is a bit more pronounced. Instead of staying in the role of someone else's victim, in a manner of speaking I become the perp, using physical violence to defeat others, and ultimately harming myself. Survivors who engage in these kinds of trauma survival tactics are often committing what can be seen as Type II errors, false negatives. They might be naive enough, or so focused on the pleasure and control of the re-enactment that they don't recognize the harm in these strategies for survival.

There are exceptions to false negatives in this stage of recovery. Two examples are apathy and conscious resignation to the locus of control shift. Apathy is when we have a general awareness that what we're doing is harmful, but we protect ourselves with the story that we don't care--sometimes out of fear that we will be overwhelmed by caring too much through anxiety and shame. An example of living by the locus of control shift is that we were conditioned to believe that we deserve to have bad things happen to us, and so we passively accept the ineffective story that we are supposed to be harmed--that's why others harmed us and it's also why we presently harm ourselves. (The locus of control shift can also be classified as a false positive; if we conclude we deserve bad outcomes before someone else declares we deserve bad outcomes, that too gives us the power of undoing.) Apathy and negative self-stories can also work in concert against us--a self-defeating combo strategy.

The internal clenching of "never again." It is natural at some point of survivorhood for a person to grow weary or defiant of encountering harm over and over; from here it is natural to shed Type II errors through one or more traumatic promises.   Such angry or exhausted internal declarations typically include the resolve of "never again." Implementing traumatic promises can look like the path taken by the cage fighter described above. It can also be done in gestures of fearful avoidance. This is not to suggest that there is a clean break in which a given survivor's strategies leap from false negatives to false positives. The transformation, even after traumatic promises are consciously articulated, probably occurs in fits and starts. But at some point in this metamorphosis, the trauma survivor becomes more situationally inclined to react over-protectively, which results in a consistent pattern of Type I errors: false positives.  

False positives occur when the survivor's environment triggers emotions and body memories from the past or fears of repeating history in the present or future. This activates the emotional resolve of the traumatic promise. It is also likely to activate a sense of unsafety, shame, and fear of failure (breaking the traumatic promise of "I swore to myself I would never go through that again"). The main past event Sheila has promised to prevent can be visualized at the dead center of a dartboard. If being literally unsafe, or having one's body bruised while being verbally blamed for the perp's actions is the "bullseye," then "near misses" and wildly false positive conclusions can be points plotted around the dartboard we are visualizing. If a bullseye is worth one hundred points and the small area immediately around it scores fifty, then being beaten up and verbally blamed and shamed by ex-boyfriend Raymond equals one hundred; that dart lands dead center. A memory of being cornered in a room with a loudly ticking wall clock where Raymond is drunk and angry, saying he can't take it anymore and threatening to beat Sheila--and she manages to escape and run to safety--could be scored as a fifty, a dart landing very close to the bullseye. It clearly qualifies as immediate danger, which Sheila narrowly eludes in the past memory.

Survivors eventually escape harm to nest in safer environments, but they can't always tell what's really safe.

For Sheila, the past trauma of domestic violence leads to self-protective (and self-defeating) "false positive" internal stories.  If we fast forward to a point in Sheila's life in which she has been emancipated from Raymond for three years, we can look at her relationship experiences with Miguel and plot those on our imaginary dartboard. The mathematical possibilities with Miguel fit those about any human, especially human males. He is hypothetically capable of violence whether he's drunk and angry or just really frustrated. It's within his range of possible options to behave in an infantile manner, tantrumming and blaming and shaming another person, and requiring the other person engage in some magical apologetic or soothing actions to codependently calm him down.

However, Miguel doesn't have a habit of acting in these ways. He has never touched a woman in anger, or blocked a doorway so she can't leave the room. Miguel often verbally expresses empathy for women who have been harmed. He once drove three hours in the middle of the night when his sister called him for help in escaping a domestically violent relationship. It's true that in his past relationship when his ex-wife Alicia would incessantly scream at him for several minutes at a time, Miguel would eventually yell at her "will you please just shut up for a minute so I can think!" and then leave, slamming the door. There were a couple of occasions when Miguel spoke harshly and spanked the family dog with an open hand to get the dog to let go after it picked up their kitten by its head--an obviously lethal risk to the kitten.

One day when Miguel is distressed, Sheila is overcome by a feeling. It is the result of being thrust from "calm and alive" (the parasympathetic nervous system state associated with ventral vagal functioning) to "stressed out" (sympathetic nervous system activation). This feeling vaguely familiar from somewhere in her past, and today her awareness fastens an unhelpful story: she is suddenly feeling the fear of danger she felt with Raymond, because Miguel is dangerous--or so she tells herself. Sheila's therapist, having met with Raymond, exercised questionable judgment in disclosing to Sheila the opinion that Raymond was a "malignant covert narcissist." Just like Raymond, she thinks, Miguel is well-liked by everybody, and tends not to emote upset feelings until they're at home and no one is around to witness it. Sheila connects the dots and concludes that Miguel must be a "malignant covert narcissist" too. Mind you, Miguel is transparently upset in Sheila's presence--in their kitchen where there is a clock that makes a constant ticking sound; but he has no history of violence, he is not physically or verbally aggressing against anyone or anything presently, he is not blaming or shaming her for his emotional state, he is not drunk like Raymond...and is not Raymond.

As she starts to shake and cry, Sheila stands in the kitchen across from Miguel, points a finger at him and says she doesn't feel safe. Miguel responds, "What in the world are you talking about?" Sheila speaks again, louder this time, except with these words: "it's unsafe for me to be around you...I need you to leave." Miguel unhelpfully replies with defensiveness, but still no aggression: "you know I am not unsafe to be around." This exchange repeats itself a few times, escalating only in verbal/emotional intensity. When Sheila threatens to involve the police if he doesn't leave immediately, Miguel retorts, "what is wrong with you?? Fine, I'll go out to the garage!" Sheila stands by her offer to involve the authorities, explicitly insisting that Miguel must leave the premises and go to his mother's house for the night. In an incredulous fit of acquiescence, Miguel leaves under protest, muttering that Sheila has "gone crazy." Sheila hears Miguel shut his car door loudly before driving away.

So many ineffective strategies to unpack! I did not reach out to see if Terry Real was available for an interview (I seriously doubt I could afford his saying "yes" to such a request). terryreal.com The story I'm telling myself is that in applying Terry Real's ideas within the paradigm of Integrated Trauma Therapy, Sheila was experiencing an adaptive child reaction to Miguel's visible state of upset. Whereas the "wounded" inner child reacts tends to react helplessly, the "adaptive" inner child (often a pre-adolescent or adolescent) decides that something must be done--and it's the most reasonable thing she can think of to do, given the resources at hand. I'm also telling myself that Colin Ross's Trauma Model would suggest Sheila is undoing Raymond's harm (and very likely, harm from even earlier in her development) by labeling Miguel as dangerous and making him leave. While Miguel's reaction was also "adaptive child," defensive and lacking necessary empathy, eventually using his own "one-up," contemptuous labels ("wrong" and "crazy")--warranting professional advice on how to be a supportive, effective communicator--Sheila's reaction contains the problematic strategy featured in this article. She is utilizing a "Type I error"...a false positive.

Sheila's feelings are valid, but her detector is malfunctioning. Sheila is in a critical stage of recovery; she needs insightful, disentangled, supportive advice. In the name of protecting herself, she is contributing to the damage of an adequately safe (if imperfect) relationship. No safe partner deserves to be treated like a dangerous partner--nor need he account for or make amends for violations he never actually committed. Sheila's activated inner child is screaming that she needs protection. What she needs is patient support and expert guidance, not protection.

Humberto Maturana referenced the above parable in the book The Tree of Knowledge: The Biological Roots of Human Understanding.

Sheila needs a therapist who knows the difference between a person who is triggered to feel unsafe and a person who is in danger of physical violence and/or is at risk for toxic emotional violence.  This is not easy to discern from the therapist's chair. But an experienced clinician with well-healed wounds of their own is less likely to be emotionally triangulated by the heart-wrenching plight of Sheila's emotional experience, seen through the lens of a protector--an inner adolescent who is desperately trying to protect Sheila's wounded inner child from the re-emergence of the symptoms of former trauma. Therapy with an inexperienced or unhealed clinician, on the other hand, could naively or codependently endorse either Type I or Type II errors. However, in my experience of working with trauma survivors' stories of advice from previous (or concurrent) therapists, the more common outcome has the triangulated professional encouraging false positives. In the past several years, at any given time, my caseload is likely to reflect as many as a half dozen cases complicated by some other therapist, counselor, psychologist, doctor or social worker declaring danger, abuse, or other severe narcissistic harm where such forces do not reside.

What You Can Do: Two levels of "know your shit." If you are at the level of clinician, passionately pursue all of your ethical obligations. "Doing no harm" includes making sure that you KNOW what the PVR triangle is and that you stay OFF it when giving advice. Therapists, counselors, social workers, psychologists, and doctors must not act like perps when treating clients. They must be adequately agile not to end up in a "victim stance" with clients. And they must know that they cannot "save" clients, and therefore should not make their own "okayness" dependent on rescuing anyone. It's like someone with a new hammer looking for nails: if you are in this profession to rescue people, your own unresolved trauma will INVENT perpetrators. It is your responsibility to prevent or overt false negatives and false positives in your clients' lives, not confabulate them or make them worse. Have the courage to seek permission to interview partners who seem to trigger your clients, interview friends and family members, and even corroborate contact with the authorities for alleged incidents, so you have the best possible handle on potential danger in your clients' lives. Be aware of when your clients struggle with presence and maybe reacting more to "then" than "now." If you the clinician struggle with mindful presence, you and your clients both deserve your commitment to improve in that area. Get therapy yourself.

If you are a survivor of trauma, to prevent false positives (and all other self-defeating stories) you must have a good understanding of your triggers and traumatic fears; that usually requires some serious involvement in good trauma therapy with an experienced, well-healed therapist--so ASK your helping professional about their professional experience, as well as what they've done personally to heal. Your therapist can protect the details they want to keep to themselves, and still give you a thumbnail sketch of what steps they've taken and how far they've come in recovery. (You deserve the same information from your general physician or psychiatrist, but I wouldn't expect a warm reception--contact me and let me know if it goes well!)

Survivors who possess well-practiced skills learned in good trauma therapy will have enhanced awareness and agency over their internal experiences in space with people they're supposed to be able to trust. They will be more inclined to understand whether a reaction is coming from the present situation, or it's more of a reminder of something scary from the past. They'll feel more capacity to conclude they are physically safe, even if they've just experienced momentary contempt from loved ones or strangers. Skilled survivors are also able to reset their mind spaces and their nervous systems. So make sure you are moving toward improved recovery and increased capacity to endure and overcome. Instead of clinging to traumatic promises, vow to love yourself by developing habits of practicing any tools that help. Practice presence with your partner. Maintain empathy with that person whenever you're problem-solving with them. Go to therapy with them when you run into issues that aren't readily resolving; I recommend someone trained in Terry Real's RLT (Relational Life Therapy), but also someone with many years of experience, someone who comes highly recommended by both men and women, by the LGBTQ community, and by surviving "victims" and "violators" alike.