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Authors: Charles W. Hoge M.D.

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One other thing that might not be recognized is that sometimes the
most painful thing for someone who has gone through severe trauma is
experiencing the difference between the world they have lived in and a caring,
loving, nurturing, andjustworld. In otherwords, an act of kindness, compassion, and caring can unravel a person who has lived the opposite for so long,
particularly if at the end of the fifty-minute session, they have to bottle it all
up and go right back to what they knew before. It's hard under these circumstances to feel any security going to therapy, even though it's necessary.

Experiencing Major Loss as an Adult

Major losses occurring as an adult (e.g., losing a battle buddy, losing a
close relationship, losing a parent or family member, losing custody of
kids, serious injury or illness, being raped or assaulted) can be just as emotionally devastating as the above example of child abuse, and can include
all of the same emotions. The initial emotions with these types of events
usually are the primary emotions of hurt, fear, sadness, grief, anger, helplessness, and powerlessness. These are often mixed with shock, confusion,
and sometimes dissociation; the pain can be felt on a physical level (e.g.,
nausea, pain in the heart, chest, or pit of the stomach).

They are then followed by complex emotions, for many of the same
reasons as in the example of child abuse. Although adults have more
awareness of what's happening, the shift from primary to complex emotions can happen rapidly; there's an automatic subconscious shift that
might be instinctual, a wall that goes up to protect the person.

The difference between the example of child abuse and major losses
as an adult is that the adult has more knowledge to draw upon and is in a
better position to find ways to cope with or respond to the loss. They're in
a better position to understand and put words to what they're feeling, to
express their emotions-both primary and complex-and to act on those
emotions. It's very difficult (or impossible) for a child to be resilient under
the circumstances of abuse because they lack the knowledge and understanding of what's happening.

Contrast this, for example, with U.S. prisoners of war in Vietnam, who
endured extraordinary suffering but who often proved themselves to be
the most resilient and remarkable men, capable of transcending and growing from their experiences. The human capacity for resilience is remarkable. Although all of the primary and complex emotions occur in adults
as well as children, adults have a much better chance at saving themselves
through greater awareness and understanding of what's happening.

Keys to Resilience

Given this information, what are the tools that you can use to navigate
your own losses? I'm convinced that there are three important keys to
resilience, defined here as the ability to bounce back after adversity and
the capacity to live with major losses: 1) the capacity to feel, express, and
accept all emotions connected with loss, particularly the primary emotions; 2) the belief in yourself and your value; and 3) a connection to any
loving person (or people) who can provide feedback and help in facilitating the expression of all of the emotions connected with loss withoutjudg-
ing you or labeling you "crazy."

It's true that genetics, upbringing, environment, and all the nature
vs. nurture theories that occupy entire libraries are also important in
resilience. However, I believe these three keys to resilience are the most
useful for each of us as individuals. The remainder of this chapter will
focus on the first two of these keys. The third, connection to a loving
person, is inherent in everything we do, and is addressed in various ways
throughout this book.

SKILL 2: EXPLORING THE CONNECTIONS BETWEEN
COMPLEX AND PRIMARY EMOTIONS

The loss worksheet you filled out in this chapter's skill 1 is intended to
help in the process of acknowledging your emotions. That might be as
far as you want to go depending on the intensity of the loss you've experienced, how recently it occurred, whether you feel like you're stuck in
complex emotions, and whether you're ready to move on. If you're experiencing mostly primary emotions, which are expected after a major loss,
the only thing you might want or be able to do is acknowledge and express
them and allow them to exist until they've shifted, however long that takes.
If this is where you are with your loss, you might want to skip to the next
section titled "An Example of Coping with Primary and Complex Emotions." (You could also read through this without spending time on it, and
if you feel it might be valuable, go back and complete it.)

If you've gotten stuck in complex emotional processes, and they're making you miserable, then this skill is designed to help. To start, look back at
the previous loss worksheet in skill 1. If you circled complex emotions and
you feel like they're interfering with your life significantly now, then continue with this exercise by circling them again on the worksheet on the next
page. The next step is to explore how they are connected to the primary
emotions. Every complex emotion is made up in part by primary emotions.
For each complex emotion that you circled, feel what primary emotions
they are connected with, and draw lines to connect them. It might be helpful to use a different colored pencil or marker for each complex emotion.

For example, if you circled "depressed," consider which primary emotions are part of this feeling. You can only do this through feeling it. Your
depression could be made up of a combination of all of the primary emotions. Use one color to connect depression with the primary emotions you
feel contribute to it. For instance, you might become aware of "sadness" or
fear" underlying the depression. If the next complex emotion you circled
was "hopeless," feel which primary emotions are included in this; there
might be sadness, helplessness, powerlessness, grief, or others. Use a different colored pencil or marker to draw lines from your feeling of "hopeless" to the primary emotions connected to this.

Change/Loss

Continue this exercise until you've identified which primary emotions
underlie the complex emotions you experienced as a result of your loss.
You will find in doing this that you can feel each of the primary emotions
that play some role in the complex emotions. There might be other factors
that contribute to the complex emotions, but the primary emotions likely
play a large role. What you're doing in this exercise is identifying which
primary emotions are causing the complex emotions. You are also identifying how your mind is working to protect you by involving you in the more
complex emotional processes. You might want to repeat this exercise for
any other loss you've experienced.

Some losses are very painful, and the primary emotions connected with
them can be next to impossible to live with, which is part of the reason why the mind creates complex emotional processes. Consequently, you might
ask why I want you to connect with these primary emotions if they're so painful. The reason is that in order to come to a place of acceptance of major
losses, it's necessary to acknowledge and express the primary emotions.
That doesn't mean that you have to live there or stay with those emotions
indefinitely, but it is necessary to recognize them, understand how they're
present deep within you, and be able to experience and express them.

An Example of Coping with Primary and Complex Emotions

Here's an example to help solidify these concepts: After returning from a
combat deployment, a soldier flies into a rage at something his wife does
and shoves her. She's not hurt, and this is the first time that this has ever
happened. The soldier feels shocked, scared, and angry with himself. His
wife had a very difficult time with their two young kids during the deployment, and she's been feeling dissatisfied with the marriage for a long time.
She responds by saying that she wants a divorce, and tells him that she
plans to move herself and the kids back with her parents.

The soldier now might feel helplessness, grief, and a strong fear of
being alone along with the other primary emotions he's experiencing.
Although the couple had some marital difficulties before deployment, the
soldier loves his wife deeply, missed her throughout the deployment, and
is overwhelmed by the pain of facing separation from her and their kids.
This situation makes him well up with tears and have difficulty concentrating. He loses his appetite and starts to experience sleep difficulties. He
asks her to go to counseling with him to try to save the marriage, but she
refuses. He feels longing for his wife and is filled with sadness and fear.

It would be understandable in this situation for the soldier to then
start to experience more complex emotions in the form of despondency,
guilt, shame, feelings of worthlessness (believing that the entire marriage
is a failure because of him alone), and depression. He might go over and
over in his mind what happened that caused him to shove his wife, as
well as all the different things that he could say or do to get her back. He
might blame himself in multiple ways through "shoulds," "what-ifs," and
"why" questions (e.g., "How could I have done that?", "Why did this hap pen", "What was I thinking?", "What should I do to fix this?", "How will
she respond if I say that?"). He might feel desperate to reconnect with his
wife. He might not acknowledge feeling angry with her for her refusal to
attend counseling because he feels like the whole reason that she's leaving
is his "fault." Ultimately, all of these feelings could progress to despair and
feeling that life isn't worth living without his wife and children at his side.

At this point the soldier has turned all of the primary emotions, particularly his grief at losing his wife and kids and the fear of being alone,
toward himself. He's incapable of staying for long with the primary emotions of grief and fear, and slides into depression and self-deprecating
thoughts of worthlessness, self-blame, or feeling that life isn't worth living.
He's unable to see value in himself, and blames himself for the entire situation, ultimately becoming filled with despair. Self-destructive behaviors
might emerge, such as drinking excessively.

Clearly this soldier needs some resiliency to get through this situation.
He may need to see a therapist or his pastor. He certainly needs to talk
with a close friend or family member who cares about him. If he were to
do the exercise in this section, then he might draw lines from "depressed,"
"guilt," "shame," "worthless," and "despair" to "hurt," "sadness/sorrow,"
"grief," "fear" (of being alone), "helpless," and maybe also "anger."

For this soldier, connecting the complex emotions that he's stuck in
to the original primary emotions will help him free himself. Experiencing
the primary emotions brings him back to a place where he feels the loss
directly without judging himself as the cause of it. He fears being alone,
but he won't be able to live alone unless he faces his fear. Once he does
that (and only when he does that) can he move on to his new life. He feels
grief at losing his wife and kids, and grief hurts terribly, but he can only
learn to live with the loss by acknowledging how much the grief really
hurts, not by trying to change it. Grief has to be allowed to run its course.

Yes, he has reason to be angry with himself, but he won't be able to
resolve that until he realizes that he's also angry with his wife for refusing
counseling, and for using this situation as her reason to leave. He feels helpless, but he won't be able to stop feeling helpless and create the possibility
of a new life for himself until he acknowledges how helpless he really feels.

Basically, primary emotions need to be allowed to run their course and
not get bottled up or locked up behind complex emotions and thought
processes. The complex emotions are ingrained processes of the mind
that help cope with the pain of primary emotions. However, they have a
huge downside that can only be addressed through awareness.

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