Book Of The Week: What My Bones Know by Stephanie Foo
CPTSD: Understanding the Lasting Effects of Relational and Developmental Trauma
What My Bones Know:
A Memoir of Healing from Complex Trauma
by Stephanie Foo
In recent years, discussions about trauma and its various dimensions have received increasing attention.
Our understanding of trauma has shifted from solely recognizing isolated traumatic events to acknowledging the more subtle and ongoing impacts of relational and developmental trauma. This paradigm shift highlights how trauma affects emotions, relationships, and personal identity.
Stephanie Foo's memoir, What My Bones Know: A Memoir of Healing from Complex Trauma , offers invaluable insight into Complex Post-Traumatic Stress Disorder (CPTSD) . This condition often encompasses a range of emotional challenges resulting from prolonged trauma. Foo's narrative not only recounts her painful experiences but also educates readers on the underlying realities of CPTSD .
Read more about the effects of childhood trauma and coping mechanisms in the detailed exploration of CPTSD below.
Our understanding of trauma has shifted from solely recognizing isolated traumatic events to acknowledging the more subtle and ongoing impacts of relational and developmental trauma encountered in everyday life.
Foo skillfully intertwines memoir and education, shedding light on the realities of trauma and the parental, societal, and environmental factors that contribute to CPTSD. She provides us with a raw and heartbreaking exploration of her experiences and the journey toward healing.
Childhood Trauma
As a journalist, documenting this journey appears to come naturally to Foo. She reflects on the challenges of living with childhood depression, feelings of abandonment, and the enduring effects of trauma, all with a sense of observational distance. This will come to make more sense— we’ll learn that from an early age, learning to detach from her emotions was means of survival. (Similarly, dissociation is a coping mechanism that many with CPTSD utilize.)
She recounts her experiences as a Malaysian immigrant of Chinese background in San Jose, grappling with the challenges of connecting with her parents who seemed impossible to please or understand. This disconnect brought dire consequences in the form of extreme physical abuse. Her childhood was characterized by instability, neglect, and both physical and emotional trauma.
*Trigger warning*
I must emphasize that the vivid descriptions of such heartbreaking abuse were challenging to digest. Those with experiences of emotional or physical abuse may want to consider skipping these chapters, as the revelations can provoke intense feelings, even for those who have not endured similar situations. That being said, the book is chock full with information and would be beneficial for those who are looking for answers, information, or guidance in their own recovery work.
Because I understand that some will struggle to engage with this material due to their past trauma, I’ll aim to provide a basic understanding of CPTSD to get you started on your own path towards understanding.
An Exploration of CPTSD
Complex PTSD sometimes abbreviated as C-PTSD or CPTSD, refers to a range of emotional and psychological challenges that occur as a response to prolonged trauma, mostly due to dysfunctional relationships and environments. Unlike traditional Post-traumatic stress disorder (PTSD), which is tied to a specific traumatic event, such as a physical assault, sexual violence, a car accident, or witnessing a death or natural disaster, CPTSD reflects the cumulative effects of continued trauma.
Complex PTSD is more likely to arise from repeated experiences of trauma, particularly during childhood, involving a series of abusive or harmful incidents spanning months or even years. The symptoms of C-PTSD are often more intense and enduring than those associated with standard PTSD.
This type of trauma typically occurs in environments where one expects care and support—like within families or close relationships—yet what is experienced instead is neglect, abandonment, betrayal, or emotional harm. It’s not just overt instances of abuse that can cause harm to children, it’s also what doesn’t happen for us that can cause harm—
Emotional neglect, in particular, involves caregivers consistently failing to meet a child's emotional needs. This includes a lack of interest, emotional support, and affection, along with disregarding the child's psychological well-being or belittling their feelings, thoughts, and experiences. Such neglect can lead to another well-studied form of trauma- Attachment trauma.
Attachment trauma is said to arise when a child faces disruptions or adverse experiences that hinder the development of secure attachments with primary caregivers. The impact of attachment trauma can be profound, leading to enduring effects on a child’s emotional development and affecting their capacity to establish healthy relationships in the future.
Attachment trauma sets the stage for challenges in emotional regulation and relationship dynamics, which can culminate in the development of C-PTSD.
In addition to the abuse at home, Foo also sheds light onto how environmental and societal factors can contribute to CPTSD:
“It isn’t just racism. Being part of an oppressed minority group—being queer or disabled, for example—can cause C-PTSD if you are made to feel unsafe because of your identity. Poverty can be a contributing factor to C-PTSD. These factors traumatize people and ca use brain changes that push them toward anxiety and self-loathing. Because of those changes, victims internalize the blame for their failures. They tell themselves they are awkward, lazy, antisocial, or stupid, when what’s really happening is that they live in a discriminatory society where their success is limited by white supremacy and class stratification. The system itself becomes the abuser.
Symptoms and Effects of Complex PTSD
Complex trauma fundamentally alters a person’s perception of safety, trust, and connection leading to symptoms long into adulthood. As a result of those attachment traumas, people may struggle to forge new relationships, as their experiences can lead them to inherently mistrust others. They may carry deep-seated beliefs that people will let them down, which can manifest in anxiety, avoidance, or difficulty in emotional closeness. Foo illustrates the emotional and psychological toll it takes on future relationships:
“Because of its repetitive nature, complex trauma is fundamentally relational trauma. In other words, this is trauma caused by bad relationships with other people—people who were supposed to be caring and trustworthy and instead were hurtful. That meant future relationships with anybody would be harder for people with complex trauma because they were wired to believe that other people could not be trusted.”
According to the National Center for PTSD, symptoms of CPTSD include:
Difficulty regulating emotions : Many individuals with CPTSD struggle to understand and manage their feelings, leading to emotional dysregulation, experiencing intense and fluctuating emotions leading to emotional outbursts, mood swings, or a sense of emotional numbness and detachment.
Negative self-perception : Those affected may experience feelings of shame, guilt, and worthlessness. They may also have difficulty establishing and maintaining a consistent and coherent sense of identity.
Interpersonal issues : Building and maintaining relationships can be particularly challenging due to distrust and anxiety. Adults with C-PTSD often face challenges related to trust, a fear of abandonment, and difficulties in forming secure attachments. They may experience recurring interpersonal conflicts, emotional detachment, and struggles with intimacy and vulnerability. Additionally, they might prioritize the needs and expectations of others in their relationships, attempting to conform to what they believe the other person desires or acting in ways to avoid upsetting them. This tendency can come at the expense of their own identity and hinder their ability to express their own preferences or opinions.
Dissociation : Individuals may experience dissociative symptoms, feeling detached from themselves or their surroundings, disconnection or detachment from one’s thoughts, feelings, sensations, or even the sense of self. Adults with C-PTSD may experience dissociative episodes as a way to cope with overwhelming emotions or traumatic memories.
Somatic symptoms: Adults may endure chronic pain, headaches, gastrointestinal issues, or other unexplained physical ailments. These physical symptoms often reflect the psychological distress associated with C-PTSD and may display the effects of managing high levels of anxiety and emotional pain on an ongoing basis.
This type of trauma typically occurs in environments where one expects care and support—like within families or close relationships—yet experiences neglect, abandonment, betrayal, or emotional harm instead.
Maladaptive Coping Strategies in Complex PTSD
In reading What My Bones Know, we gain a nuanced and valuable insights into the intricate psychology of trauma and the maladaptive coping strategies that we employ to navigate these difficulties. While these mechanisms may inadvertently lead to increased pain over time, it's essential to acknowledge how they aid in our survival in the absence of alternatives.
Foo reflects on several maladaptive coping mechanisms she developed, such as dissociation and anxiety, as well as a tendency to center herself in various situations. These responses continue to influence her adult life. Some key points she highlights include:
Centering the Self in CPTSD
Many people with CPTSD tend to center their experiences around themselves—as a way to regain a sense of control over their chaotic environments. Foo notes:
“People with C-PTSD often assume that problems are centered around them—not out of selfishness or narcissism, but rather because they seek a sense of control to effectively address the issues at hand.”
Having grown up feeling a pervasive lack of control over their environment and relational dynamics, many with CPTSD may mistakenly believe that blaming themselves will help them regain agency and solve their problems.
Covering Up Vulnerability
Another common coping mechanism for many is the suppression of vulnerable feelings such as sadness, fear, or insecurity. This behavior often arises from the fear that expressing vulnerability could lead to rejection or further emotional pain (this fear was warranted given Foo’s parents reactions to her expressions of vulnerability.) As a form of self-protection, many opt to mask these vulnerable emotions.
Foo states:
“Hatred, I learned quickly, was the antidote to sadness. It was the only safe feeling. Hatred does not make you cry at school. It isn’t vulnerable. Hatred is efficient. It does not grovel. It is pure power.”
By masking their true feelings, those with CPTSD may unwittingly hinder their healing process, clinging to emotions that provide a false sense of strength. Unlike sadness, hatred can fuel a sense of agency and strength and doesn't evoke the same level of emotional exposure.
The Role of Dissociation
Dissociation represents another coping strategy, where individuals disconnect from their emotional and physical selves to manage overwhelming feelings. Foo explains:
“Dissociation exists for a reason. For millennia, our brains and bodies have removed us from our pain so we can keep moving forward. A tiger just ate your wife? Bummer, but breaking down or freezing up is not an option. You better go out hunting today or your kids will starve. Your house was just destroyed in an air raid? Okay, but you have to pack up what’s left and find new shelter, now. Feelings are a privilege.”
This survival mechanism, effective in the short term, can lead to long-term disconnection from one’s emotions and bodily experiences.
The Impact of CPTSD on Physical Health
Foo emphasizes the extensive repercussions of childhood trauma on both mental and physical health. Research highlighted in her memoir reveals:
“The more childhood trauma someone had suffered, the worse their health outcomes were in adulthood…Scientists have learned that stress is literally toxic. Stress chemicals like cortisol and adrenaline surging through our bodies are healthy in moderation—you wouldn’t be able to get up in the morning without a good dose of cortisol. But in overwhelming quantities, they become toxic and can change the structure of our brains. Stress and depression wear our bodies out. “
Excess levels of stress hormones, such as cortisol, can adversely affect brain structure and overall health. She highlights the connection between childhood trauma and the shortening of telomeres —protective caps on DNA strands that can lead to increased susceptibility to diseases and a shorter lifespan.
Foo underscores the importance of understanding that the effects of trauma extend beyond emotional turmoil, profoundly impacting physical health and reshaping our very biology.By illuminating the scientific underpinnings, she underscores that the effects of trauma extend far beyond the emotional realm, reverberating through our physical well-being and even shaping or reshaping our very biology.
Healing From CPTSD
In her insightful narrative, Foo candidly describes her experiences with various healing modalities, including therapy, meditation, and the importance of community and support systems. She documents the books she’s read, interviews with psychologist and scientists, therapies tried and what she learned along the way. Notably, she tries out many of the therapies discussed in The Body Keeps the Score, including talk therapy, EMDR, support groups, yoga, and meditation. She thoughtfully examines which approaches were beneficial and which were not. The accumulated knowledge she has gathered from years of fervently seeking answers ultimately enables her to create her own ideal blend for healing.
it’s not just overt instances of abuse that can cause harm to children, it’s also what doesn’t happen for us that causes harm—
The Importance of Relational Healing In CPTSD
Foo emphasizes that healing from trauma is fundamentally relational. Trauma often stems from interpersonal dynamics, making "self-healing" a challenging concept. By fostering new, positive interactions and meaningful engagement with others, individuals can gradually rebuild a sense of security that reshapes their perceptions of relationships and the world around them. Ultimately, healing thrives within the embrace of supportive connections.
An Integrative Approach to healing
I resonate with Foo’s belief that addressing C-PTSD demands a comprehensive and integrative approach that acknowledges each individual's unique complexities. Effective therapeutic interventions may include:
Trauma-Focused Therapy
Psychodynamic Therapy
Attachment-Based Therapy
EMDR
Relational Therapy
Integrative Methods
The Therapeutic Relationship
Foo stresses the therapeutic relationship is essential, as it provides a safe and supportive space for people to explore their trauma and ultimately foster a secure attachment through the therapeutic relationship.
Ultimately, healing is not merely an internal endeavor; it flourishes within the embrace of safe, supportive connections with others.
Foo’s Powerful Reflections on Healing
Foo captures the essence of healing:
“So this is healing, then, the opposite of the ambiguous dread: fullness. I am full of anger, pain, peace, love, of horrible shards and exquisite beauty, and the lifelong challenge will be to balance all of those things while keeping them in the circle. Healing is never final. It is never perfection. But along with the losses, there are triumphs. I accept the lifelong battle and its limitations now. Even though I must always carry the weight of grief on my back, I have become strong.”
She poignantly asserts that:
“Being healed isn’t about feeling nothing. Being healed is about feeling the appropriate emotions at the appropriate time and then coming back to yourself. That’s just life.”
And also reminds us:
“Over and over, the answer is the same, isn’t it? Love, love, love. The salve and the cure. In order to become a better person, I had to do something utterly counterintuitive. I had to reject the idea that punishing myself would solve the problem. I had to find the love.”
CPTSD Recovery Work: Steps to Healing
Healing from CPTSD is not only possible; many find ways to reclaim their lives and inner peace.
Here are some steps that one can take:
Seek Professional Support : Engaging with a therapist specializing in trauma can be transformative. Approaches such as Eye Movement Desensitization and Reprocessing (EMDR), Cognitive Behavioral Therapy (CBT), and somatic therapies are effective in addressing the symptoms of CPTSD. While there is no one size fits all approach to trauma work, a supportive therapist is essential as they can help create a safe environment for processing trauma and developing coping strategies.
Build a Support System : Surrounding oneself with understanding and empathic support is crucial. Support groups can provide a sense of community and connection, validating the shared experiences of trauma.
Regulate the Nervous System: Many with CPTSD experience hyperarousal, which includes symptoms like anxiety, irritability, and difficulty sleeping. By learning to regulate the nervous system, people can employ techniques such as deep breathing, mindfulness, and grounding exercises that activate the parasympathetic nervous system, promoting relaxation and reducing anxiety. A well-regulated nervous system enables people to better manage their emotional responses. This resilience helps in processing emotions more effectively, allowing for healthier coping mechanisms rather than resorting to maladaptive responses like avoidance or substance abuse. Incorporating practices such as mindfulness, yoga, and creative outlets can help foster a sense of grounding.
Set Boundaries : Understanding and establishing healthy boundaries is essential in the healing process. It is vital to prioritize your emotional well-being and to recognize when certain relationships may not serve your journey.
Educate Yourself : Knowledge is a powerful tool in the healing process. Learning about CPTSD, its symptoms, and effective coping strategies can empower individuals to make informed decisions regarding their treatment and self-care.
Embrace the Journey : It’s important to remember that healing takes time. Celebrate small victories and understand that it’s okay to seek help during difficult times. The quote “The wound is where the Light enters you” emphasizes the potential for growth and transformation through adversity.
Why Read This Memoir?
What My Bones Know transcends a mere account of pain; it is an inspirational tale of resilience and the potential for healing and serves as an essential guide for those seeking to navigate the complexities of trauma and discover paths to healing. Her writing is both candid and insightful, encouraging readers to confront difficult emotions while imparting a sense of hope and community. For anyone affected by trauma, Foo’s memoir provides both clarity and compassion—a reminder that healing, although challenging, is indeed within reach.
TRIGGER WARNING: LOTS OF EXPLICIT DISCUSSION OF CHILDHOOD ABUSE.
Resources:
The National Child Traumatic Stress Network -https://www.nctsn.org/what-is-child-trauma/trauma-types/complex-trauma/effects
Dr. Arielle Schwartz website- https://drarielleschwartz.com/practical-guide-to-complex-ptsd/
Reading For Clients: A Practical Guide to Complex PTSD by Arielle Schwartz
Reading for Clinicians: The Complex PTSD Treatment Manual: An Integrative Mind-Body Approach to Trauma Recovery by Arielle Schwartz
References:
Maercker A, Cloitre M, Bachem R, Schlumpf YR, Khoury B, Hitchcock C, Bohus M. Complex post-traumatic stress disorder. Lancet. 2022 Jul 2;400(10345):60-72. doi: 10.1016/S0140-6736(22)00821-2. PMID: 35780794.
Horesh, Danny, Lahav, Yael When one tool is not enough: An integrative psychotherapeutic approach to treating complex PTSDPY - 2024/04/05 VL - 80 DO - 10.1002/jclp.23688 JO - Journal of clinical psychology
HI, I’M ANGELICA MAGANA, LMFT
My own path toward healing led me to explore many different avenues of wellness. Ultimately, I found that there is not one path but, instead, many different instruments for attaining health. For all these reasons, I gravitate towards a holistic approach that nurtures both mental and physical well-being in my practice.
