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What is considered trauma in therapy?

As a trauma therapist, faculty, and in charge of the curriculum of one of the best postgraduate trauma studies programs in the US, I struggle to convey the correct response to this question. There are many different definitions and the word is used to refer to different things even by the most renowned professionals and academics. Sharing a common understanding of what trauma really is, has relevance in terms of psychoeducation and normalization of the decease. It’d be great if we therapists agree on the terminology of trauma in order to avoid confusing our clients, refrain from over pathologizing them, and help them healing sooner.The recognition of psychological trauma is a recent development. It was not until after the Vietnam War, when the evidence for the mental consequences on veterans was overwhelming, that PTSD was accepted as a mental disfunction, included in the Diagnostic and Statistical Manual of Mental Disorders (DSM) as a disorder, and its treatment started to be funded. Even when trauma goes way beyond the consequences of war or extreme events, and takes many more forms than only PTSD, insurance companies don’t cover much more than “tragic” events, and dismiss all the other faces of traumatization.There are amazing advocates and researchers coming up with new findings of trauma every day. At this point, the significance of trauma among mental disorders is undeniable, but there is still a long way until we fully comprehend all its ramifications and consequences.Let’s start by differentiating the several ways the word trauma is used.The word trauma appears in many different publications defining:an eventan experiencea reactiona responsea mental disorderTrauma as an eventTraumatic events are those that make people feel threatened, anxious, or frightened because it’s potential to cause physical, emotional, spiritual, or psychological harm.Examples: rape, bullying, oppression, racism, emotional abuse, emotional neglect, car accidents, surgery, natural disasters, foster care, entrapment, betrayal, poverty,…Trauma as an experienceAny event could end up causing trauma if the reaction to it exceeds the capacity of the person to stay regulated.How someone experiences the event is what will determine if it’s traumatizing or not. A traumatic experience depends on your perception of risk and is very individual. For a baby, being wet, cold, or hungry for “too” long can seem life-threatening. For an adolescent, flunking an academic year or being expelled from the team can seem life-threatening; for a mother with children breaking up from a romantic relationship can seem the end of the world.Trauma as a reactionOur innate survival mechanisms trigger a series of reactions with the sole purpose of keeping our system running. The best known is the fight-flight response, and many people call this reaction trauma.Fight-flight is only one of the reactions triggered by a traumatic event that can end up traumatizing the system, but there are several others: Orienting, Attentive immobility, Social-engagement, Freeze, Tonic Immobility, Collapse Immobility, and Quiescent Immobility. I have a very extensive description of each in my blog in case you are interested.Trauma as a responseWhen danger is perceived, fear triggers a series of mechanisms that act without our consent, generating all sorts of changes in ordinary functioning because the brain interprets fear as an indication that there is the possibility of “not making it” — not only staying alive but also maintaining one’s health, social position, family, jobs, assets, freedom, autonomy, stability, etc. The obvious response to such an impact in our system is to feel overwhelmed. Under the trauma lens, being overwhelmed means that we experience many emotions at the same time, or a few of them in an extremely intense way. That response takes us out of the “Window of Tolerance” which means that we lose control over our behavior, thoughts, reactions, etc. This level of reactivity is called dysregulation and will keep the cascade of changes in the system to continue in charge. If we don’t regain control over our response, we will probably stay traumatized. But if we deactivate the survival mechanisms by activating the executive functions of our brain, we would have really won the battle. The response by itself, even if never becomes trauma, may present symptoms that may leave marks. The response to a shocking event will keep very vivid memories with some emotional charge, and may leave you hypervigilant for a while. But most of the effect of the response will fade away on themselves. Still, few symptoms could stay as a consequence of the response of the nervous system; many people call this PTS as in post-traumatic stress. Some of them may sound almost identical as the ones on PTSD but the difference is that PTS will not be as debilitating and they will be winding down as days pass.Example: Hyperactivation, hypoactivation, dissociation, flashbacks, alertness, restlessness, etc.Trauma as a mental disorderPTSD, C-PTSD (complex), Developmental trauma, Attachment trauma, Intergenerational trauma, are some of the most common terms used to describe the mental disorder.The difference between a reaction and a disorder is worth expanding. The way we react to danger has been in our systems since before we were humans. These reactions assume a danger that fortunately, we don’t have to endure anymore. Still, we are wired to react as preys and consider anyone that attacks us, as a predator. That of course, assuming that we have not evolved at all. But we have, and besides the primitive responses of our autonomic nervous system (ANS), we count on with a very developed neocortex (prefrontal cortex specifically) that gives us the capacity to control the primitive responses.Not everyone that suffers a traumatic event, develops a mental disorder. We may go through traumatization, but we may not develop trauma. here is the difference between both:TraumatizationThis is the process that your system goes into after perceiving danger. The cascade of reactions makes changes in your functioning to keep the body alive. That process is really tolling to the system and can leave complications in your memory, perception, physiology, etc.Traumatization can end when the danger is gone, or can continue after, depending on how your mind deals with the event. If you are still scared even when the situation turned in your favor and you are safe, the traumatization will continue.Traumatization can end up as a mental disorder, but not always. It can dissipate in hours, days, or weeks if you are safe and feel safe. Once your cortex sends the signal to the amygdala that the risk os over, the body will naturally try to go back to normal. The brain prefers equilibrium over chaos. According to the bible of psychiatry (DSM), if symptoms last for longer than 1 month, the diagnosis of PTSD can apply.TraumaSuffering from trauma assumes that the disorder has developed fully and it has become “permanent.” All the changes suffered during the traumatization have left sequelae and the system now functions in a dysregulated way on a regular basis. It will not disappear by itself; it will need interventions in order to heal.The most significant changes are:Loss of homeostasisDysregulated nervous system: tendency to stay hyperactivated, hypoactivated, or having both sympathetic and parasympathetic in overrideLoss of tolerance to affect; easily overwhelmed and overreactive.Antonieta Contreras, LCSW-R, CCPT-II, BCNFaculty, supervisor, Curriculum Chair at the Institute for Contemporary Psychotherapy (ICP). In private practice in NYC

Do narcissists come from unloving families?

The thing I find most hilarious here on Quora is the notion that *narcissists* don’t feel love (I use the term “narcissists” in asterisks because narcissism is a spectrum; not every person with narcissistic traits is full on NPD. Here, I will be speaking directly with regard to NPD).We still occupy human minds and human bodies, therefore still have a human experience (regardless of what we’d have you believe).So do narcissists come from “unloving” families?Depends how you define “love.”If you mean by the neurotypical terms of love, then yes.If you mean by NPD standards, then no. We are just as normal at our Thanksgiving table as you are (see my apropos timing there?). But then again, maybe it’s really that we are good at mimicking the part…?I didn’t come from an “unloving” family. I came from a disordered one.Meaning, in my family, we all loved each other very much; but in such a disordered way. Most of us (like, 85%) are personality-disordered in some way or another.Did that mean we didn’t love each other? Does that mean I do not miss them like hell and not reminisce about them during the holidays? Absolutely not.It may be/have been disordered, but it’s what we knew/know.Don’t get me wrong, I’m not justifying by any means any form of disordered love. An abusive love is just that nonetheless; an abusive one.But if by “loving” you meant, did we love each other? Of course we did.If by “loving” you meant “healthy,” then no, of course it wasn’t.Side note: I speak about my family in past tense because my family dwindled from what I knew as a child to literally 1/8 of its size. It seems as though we lost everyone in a span of about the last ten years. NPD will catch up with you; either by sickness of the mind or sickness of health. Either way you’re doomed.I can count no less than ten family members spanning over five generations that met the diagnosable criteria for Cluster B personality disorders (some actually having received an official diagnosis); 8/10 of them being NPD. That’s only on my maternal side (I highly suspect [rather, know, emphatically] there’s more on my paternal side, but I didn’t have the chance to know them personally, thus cannot give you the numbers there. Albeit, know there was definitely NPD over there, without a doubt).Of course we “loved” each other.We were codependent.We would stonewall each other.We love-bombed each other at various different times in our lives.We constantly played each other.We constantly idealized/devalued then reidealized/redevalued each other at various different times in our lives.We constantly discarded each other.We constantly hoovered each other following our various discards.We constantly hated each other.We constantly wished for peace as often as we hated each other (and meant it but were too disordered to follow through).We were constantly suspicious of one another.Peace treaties and loyalty ties were unstable, constantly shifting, short-lived, and constantly tested.Is any of this sounding familiar?My roundabout point here is:Someone with NPD (or any Cluster B personality disorder) doesn’t emerge in a vacuum.They typically come from a long familial line of disorder. We love each other but in disordered ways- the only ways we know and understand love. To us, “neurotypical love“ is a foreign construct. When you love us in a neurotypical way, it literally doesn’t compute.Side note (this one will be a most unpopular opinion, but I’m just going to say it anyway): this is why I’m completely convinced that relationships between neurotypicals and disordered individuals actually don’t exist. I’m convinced that if you’re someone that has engaged in a relationship with a disordered individual, it’s most certainly because that type of union is normalized for you. It doesn’t mean you’re necessarily disordered yourself, and it also doesn’t mean you’re responsible or at fault. But I do believe it means it’s been normalized for you at some point in your history, on some level. Otherwise, why would a neurotypical and a disordered individual engage? They literally don’t speak the same behavioral language, and thus would be repelled by one another. I say this because, when it comes to romantic relationships, I know I am literally repelled by the behavioral language of a neurotypical. Every disordered individual I know is this way. Every disordered Quoran I follow of that follows me is this way. I am not alone and am not a statistical anomaly in this experience.But back to my answer:Yes. We sat around our Thanksgiving table and shared laughter just as you and yours do. We shared tender moments just as you and yours do. We shared fondness just as you and yours do. We had moments of transparency with each other just you and yours do.The rest of the time was pretty f***** up.But f*** if we didn’t love each other in those moments.F*** if I don’t miss every single one of them this time of year.F*** if their memories aren’t sitting upon my bookshelf as we speak.F*** if I don’t think and speak fondly of each and every single one of them every chance I get.…and f*** if our five-generation family photo doesn’t look amazing on my mantel.

How did Shyam Sankar join Palantir?

I found out about Palantir in February of 2006, when a friend mentioned that there was this small, stealthy, but very exciting software company looking for its first business hire for a role that was largely actually technical. He introduced me to one of the founders, and after seeing version 0.7 of the app, meeting a bunch of brilliant people, and hearing about the mission, I knew where I had to go. Less than two weeks later, I joined as employee #13.That’s the short version of how I came to join Palantir, but I’d argue that the why is much more important. It goes back to my parents’ struggles, and how those experiences informed my values and aspirations. Their story is simultaneously an unlikely one, and a quintessentially American journey.My father grew up in a mud hut in Tamil Nadu, India, the youngest of 11 children, 9 of whom survived childhood. He was the first person in his family to attend college, which required the combined incomes of his parents and eight other siblings. He studied pharmacy because there were no other openings for his caste in the medical school. Following college, he shipped off to Lagos, Nigeria, to build and run the first pharmaceutical plant on the continent. I was born in Mumbai, where my mother grew up, but my family moved back to Nigeria as soon as I could travel. When I was two years old, five armed men broke into our house and beat my father. They demanded money from the company safe, which my father handed over, but were about to kill him anyway before one of the men advocated for sparing our lives. It was time to start over.We settled in Orlando, where my father opened a plant for a company that sold T-shirts and knickknacks to theme parks. He built a $20 million business from the ground up, but the owner gave him no equity and fired him the day he sold the business. My parents started over again, opening a dry-cleaning business, only to be forced into bankruptcy four years later. My father became a pharmacy technician while studying for his US equivalency exam and my mother worked as a grocery store cashier while attending nursing school. Eventually, my father ran a mail-order pharmacy, and my mother became a bone marrow transplant nurse. After years of working in the family businesses, I interned for the tech department of my father’s employer the summer between 11th and 12th grade, learning Perl, Linux, and a love of software.The following summer, I got my first software development job, which I continued for 30 hours per week while at Cornell. I was given equity, which was ultimately worth more than my student loans, and was also subsequently taken away – a hard lesson in reading the fine print. Later on, I started a business process outsourcing company, and took a leave of absence to pursue it full time. Although we actually became cash flow positive, it wasn’t ultimately viable, and I returned to Cornell to finish up.Following Cornell, I headed to Stanford to do a master’s program in Management Science and Engineering. Stanford was secretly a vehicle for becoming a part of the Silicon Valley community, and while I was still a full-time student I joined Xoom, an international money transfer startup, first as an intern and soon after as employee #5. This required me to renege on an offer from Boston Consulting Group. My father urged me to take the risk and fight the machine, and gave his blessing.While I started in product management at Xoom, I quickly shifted into business development, traveling all over the world setting up partnerships with banks big and small. Xoom took me not only to some of the world’s great cities, but throughout the developing world, including India, Southeast Asia, the Middle East, northern and sub-Saharan Africa, and Latin America . After migrating from the dangers of Lagos to the hardscrabble (but comparatively secure) Orlando years to Cornell, Stanford and San Francisco, I found myself back among the mud-walled villages of my father’s childhood. Technology, a one-way ticket out of the Third World for so many people, had instead brought me full circle – or so I thought.It wasn’t until I found Palantir, however, that I realized how much the collective weight of my parents’ experiences, and my own, had shaped what I really wanted to do with my life. As much as I admired the vision of the founders, the quality of the engineers, and the elegance of the product, above all I saw a chance to fully engage with what was most important to me. Palantir has been a deeply personal experience, in ways that are still being written.It all began with the commitment to solving world-changing problems. The foundation of Palantir is a belief in the potential of human-computer symbiosis, and the possibility of doing something transformative for the world is a potent lens for evaluating both personal and technical potential. Here was a definitive answer for those moments when I honestly wondered “why not to settle into finance or consulting?” From a technical perspective, the contrast was equally stark, especially in 2006, the apex of the Web 2.0 explosion. At the time, I did not fully appreciate that technology is truly the most leveraged way to solve problems, but when Bob McGrew told me he wouldn’t have dropped out of his Ph.D to build a better calendar app, I had some idea what he meant.In a way, I saw Palantir as a modern throwback to the Silicon Valley of the 1950s -1980s,where the emphasis on solving humanity’s existential challenges was actually a defining force that brought together government, venture capital, and entrepreneurship in a way Palantir unconsciously strove to emulate. For all its merits, Silicon Valley can definitely be too insular, and this is often expressed both through lack of engagement with the world at large and in a lack of perspective about the true value and potential of technology. Even today, you hear people talk about designing spammy Facebook games as though it were actually a world-changing problem, but what’s more troubling is how readily this is accepted. By contrast, I saw in Palantir a firm recognition that the rest of the world needs Silicon Valley more than ever.When I joined, Palantir was focused exclusively on the problems of national and transnational security. However, there was a strong sense that they weren’t building one-off, bespoke solutions (the accepted norm for government contractors—something we were not) but rather solving specific problems with the goal of abstracting them to whole classes of problems. Of course, we have a much clearer idea of how to actually do this now than in 2006, but it was a fundamental part of the vision. Inevitably, I think back to my father running the mail-order pharmacy. He loved this job because he got to focus more on supply chain optimization than plain pharmacy, and working alongside him, I began to grasp that making a living is a necessity, but having the freedom to look at the bigger picture is a special privilege.Palantir’s motto, “Save the Shire”, carries a heavy layer of geek humor, but the intent behind it is quite serious. 9/11 – and the many well-intentioned but suboptimal technical and bureaucratic responses to it – was a profound wake-up call that no one was safe anymore, not even in America. Yet much of the world has never felt safe, and in the years since 9/11, there have been all too many painful reminders. The 2006 Mumbai train bombings were a potent and highly personal example (my uncle was among the victims). The 2008 Mumbai attacks were likewise tragic by any measure, but the fact that they took place in the city of my birth added an even greater sense of shared vulnerability and shared responsibility.Palantir also appealed in a very visceral way to my sense of fairness, especially in light of my father’s business experiences. I’ve noted elsewhere (http://shyamsankar.com/only-in-america) that fairness and meritocracy explain a great deal about America’s continued dominance in software development, and Palantir’s philosophy exemplifies this. It begins with giving everyone a meaningful equity stake, and permeates every aspect of how you treat each other, but that is only part of the story. In some ways, it’s easy to reward individual contributions or enforce the policy that the best idea wins when you’re a company of a dozen people. 700 employees later, these commitments are just as firm.Lastly, and perhaps most importantly, my belief in Palantir was rooted in an even deeper belief in America. My parents’ journey showed me that America is not a place where everything is perfect, but it is a place where anything is possible. America didn’t shield them from hardship or injustice, but it provided countless opportunities to start over, and the most level playing field in existence for my own aspirations. There were no laws to prevent companies from cutting their rank and file employees out of their equity, but the freedom to shape a company according to the principles of shared sacrifice and shared reward was more profound. In Palantir, I saw everything that makes America special, and I also felt a deep sense that our good fortune imposes a responsibility to ourselves and the rest of the world. In Palantir, I saw a rare chance for Americans to once again lead the way in a most vital enterprise – not only in terms of technical excellence, but also commitment to privacy and civil liberties, ingenuity in the face of global challenges, and contribution to a greater good.

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