The Home I Know: Recovery
Chapter 16
Thank you for your interest in the section of my memoir below. If your email server clips the message, then you can read the full post on Substack. You can also listen to the post by clicking the audio button at the top of this page. When needed, visit the Bibliography and Support Resources. This post mentions incest abuse. If you’re seeking resources, head over to Incest AWARE or Sibling Sexual Trauma.
PART IV: HEAL
“…How do you get through? Sometimes you don’t survive whole, you just survive in part. But the grandeur of life is that attempt. It’s not about that solution. It is about being as fearless as one can, and behaving as beautifully as one can, under completely impossible circumstances.”1
~ Tony Morrison
Chapter 16: Recovery
“Many abused children cling to the hope that growing up will bring escape and freedom.
But the personality formed in the environment of coercive control is not well adapted to adult life. The survivor is left with fundamental problems in basic trust, autonomy, and initiative.
She approaches the task of early adulthood ― establishing independence and intimacy ― burdened by major impairments in self-care, in cognition and in memory, in identity, and in the capacity to form stable relationships. She is still a prisoner of her childhood;
attempting to create a new life, she reencounters the trauma.”2
~ Judith Herman, MD
~ ~ ~
One weekend, my colleagues and I traveled to a center nestled within the mountains to lead a retreat for the high school students. The lodging rested on land that held a labyrinth in the middle of a field. Labyrinths began during the Middle Ages for religious pilgrims who were too economically impoverished to travel. Pilgrimages provided a way for wealthy believers to be freed from their sins. Labyrinths, on the other hand, allowed those without means to create a circle of stones, begin a prayer, travel to the center, then find their way out again. This process represented a pilgrimage in place, their sins forgiven through their sacred steps.
Before the students arrived, I approached the coil etched into the earth. I stepped through the circular stone creation confident I could find my way through and back out. The labyrinth created a mini-pilgrimage that had a fixed beginning and ending. But processing my family’s treatment of me and healing from sexual and emotional incest abuse didn’t feel as certain as the length of a labyrinth, freeing myself from someone else’s sins. It felt more like an actual maze. A number of ways, tricks, wrong turns, expensive missteps, a directionless game with a clear start and an unclear end. I didn’t know where the center would be, nor how I would find my way out again, but I had to begin. So, my healing journey became a pilgrimage in place.
In my free time after work or on the weekends, I googled “incest abuse” or other common phrases to find support for my recovery journey. Search results mostly showed pornography and chat room threads that encouraged incest. When I researched the offerings of rape crisis centers, I was surprised to find that organizations had no incest-related content or programs on their website either. Instead, the rape support network used a crisis intervention strategy that offered direct services to adults who had been raped recently: awareness education, short-term counseling, healthcare navigation, rape test kits, and legal consultations.3 The first step is to help survivors connect to who they were before the assault, to process the assault, and then to help them recover a new sense of identity, health, and safety after the assault.
However, studies suggest that in cases of intrafamilial child sexual abuse (ICSA), the sexual violence starts younger, is more severe and often serial, as well as continues for longer periods of time than abuse in other contexts.4 Domestic Violence Shelters offer transitional housing and social services for women and kids experiencing intimate partner violence (IPV), while Sex Trafficking Centers do the same for survivors of human trafficking. Children’s Advocacy Centers (CAC) provide similar programs for kids under the age of 18 and their families through group homes, foster, and kinship care.
However, no basic needs nor long-term services were provided to adult victims seeking to liberate themselves from family. The foundation of rape recovery models had so far assumed that survivors had support from family or could support themselves. At least when I was living at home, my basic needs — food, shelter, clothes, and recreational activities — had been provided for me.
Where is the safe place to land for sexual abuse survivors by family members? When our bodies fail us, when our families abandon us, when institutions betray us, where can we go?
I started at another physician’s office. “Do you have or have you had any of the following conditions?” The form required my medical history. So, I filled it in.
Acne - Check
Anxiety - Check
Fatigue - Check
Insomnia - Check
Suicidality- Check
Back pain - Check
Pelvic pain - Check
Depression- Check
Night terrors - Check
Digestive stress - Check
Food sensitivities - Check
Emotional dysregulation - Check
Self-harm - Check
“Anything else you’d like to add?” I wrote in the notes below: survivor of surgeries, seizures, and serial sexual abuse by family members. According to studies, all of my symptoms were common for incest abuse survivors. Incest has negative neurological, psychological, and physiological impacts. A nervous system that has been flooded with stress hormones throughout child development due to abuse can struggle to find a regulated baseline and lead to both over or under activity, as well as skin and heart issues, depression and anxiety, digestive stress and chronic pain, increased rates of suicidality. Incest can be fatal. If not immediately, then slowly taking years off of a victim’s life.5
“Emergency contact?” My heart fell into the pit of my stomach. I didn’t have one. Loneliness still rested heavily within me. Of course, this was normal after leaving my entire family to seek safety, but I hadn’t thought about how foundational family would be in navigating so many day-to-day life activities. Family-related questions were asked so frequently, even security screenings on websites asked about family histories.
So I called Charlotte — the mother of my nanny family back in Berkeley — to see if she’d replace my mother as the person to call for my emergency contact. Thankfully, she agreed. But when I took the list of my symptoms to doctors — some covered by health insurance, but many not — I continued to be met with less than helpful solutions.
In an in-patient model, various experts in clinical areas work together to help the patient’s brain, body, and being, and then find a manageable baseline. Conversely, the out-patient model puts the responsibility of continued and connected care on survivors. It’s up to them to advocate for the treatment that they need and keep their numerous doctors informed of their process. For many incest survivors, this feels like a full-time job. In my case, the network of appointments, test results, and records got lost between the various medical systems, constantly keeping me waiting for more information, or on phone calls trying to make sense of the process.
One physician told me dismissively, “You’re too young to feel this way.” Another doctor told me to just keep talking about the trauma.
But who was I supposed to talk to?
Although the issue of incest has always been taboo, the word itself was used regularly in medical, social, and educational settings before the 1990’s in the United States. Often patient intake forms, non-profits, and programs asked about or specialized in the care of victims of incest. The largest anti-rape organization today, RAINN — the rape, abuse, incest, national network — was founded in the early ‘90s.
However, due to backlash, the issue of incest became so stigmatized that funders restricted resources and social, medical, and academic settings ceased to focus on the issue.6 The word itself was nearly erased from daily usage, including by the lips of even those experiencing it. The anti-sexual violence movement shifted focus away from the home and focused on abuse by strangers, trusted people in a victim’s life outside of family, and the prevalence of sexual violence within the cultural dynamics of institutions. Without recent prevalence data, funding, and language, many victims and upstanders don’t know how to prevent, identify, or intervene in cases of incest. The lack of training in medical, social services, and educational contexts leaves professionals without the tools to help victims and survivors within their care.
Desperate to find options, I continued to seek solutions, most of which I had to pay for out- of-pocket. Acupuncture and Chinese Herbs were the first alternative healing modalities I explored after earning a more stable paycheck. I laid there with needles poked all over my skin, while emotions traveled through my body like I had never felt before. An ocean of grief poured out of me with the words:
Annie, you’re so hard on yourself. I could hear a voice of empathy settle into my mind. Be gentle. You’ve been through so much. Love yourself through this process.
It was as if the needles in my skin poked holes in the wall of the emotional dam I had built in my body to survive. The problem was that I didn’t know how to hold, how to heal, nor how to love myself. How to gently let out all that emotional water. After the session, my acupuncturist removed the needles and sat me down.
“Your gut and your brain are intimately connected,” she explained. “So considering all your body has been throught, it makes sense that both are under a significant amount of stress.”
She loaded me up with herbs poured into pills to take throughout the day to heal my gut from its weight. To release the shit — literally and figuratively. The toxins of trauma trapped in my body. Daily, I popped these pills before meals, with meals, after meals, at the next meal. Embarrassed, it was a constant reminder that I was sick. I knew no other 24 year olds required to take this many supplements. I was different and hated myself for it.
My acupuncturist recommended me to my next physician, Dr. Jeanette, an EMDR therapist (Eye Movement Desensitization and Reprocessing), to help me navigate the twists and turns in this internally unsafe environment, while simultaneously adjusting to adult life without family. I walked up to Dr. Jeanette’s front door. She opened it and welcomed me in. I loved her the moment I saw her. She was tall and slender with beautiful blond hair. A former swimmer in her sixties, she wore straight legged jeans, a pressed Ralph Lauren collared shirt, and Ed Hardy kicks.
I crossed the threshold of her front door and sat in the blue leather chair, then pulled a blanket onto my body for comfort, mostly to hide my anxiety as I prepared myself to shed my skin and share my vulnerabilities with yet another physician. A massive Great Dane therapy dog laid to my right, while Dr. Jeaneatte sat before me in an old wooden rocker with her clinical folders on her lap.
“What is the safest place within your memory?” Dr. Jeanette asked kindly.
The answer arose immediately, “The ocean.”
“Whenever you’re afraid, imagine yourself there.”
Dr. Jeanette taught me that imagining a peaceful place where one feels safe tricks the brain into believing it’s actually safe, so the body can learn to regulate. Quickly my mind began to spend the most amount of time with the ocean, and my body to remember what it was like to be back at the beach where I first felt loved.
Growth felt steady, but too slow. The urgency of healing still rushed through my brain, body, and being like water after a dam removal. It was overwhelming. Through self-study, I began to learn more about the science behind my symptoms. The brains of incest survivors often show damage in the CD45 RA-to-RO ratio compared to those raised in safe family systems. CD45 cells serve as the memory of the immune system. There are a few types of CD45 cells including RA and RO cells. RA cells activate by previous exposure to threat, while RO cells are prepared to manage new threats that the body has not yet met. The ratio between them shows the balance or imbalance between the brain’s ability to perceive present threat and prepare for future trauma. In the brains of incest abuse survivors, the proportion of RA cells largely overcomes the RO cells, meaning we are prepared to defend ourselves from threats even during neutral circumstances and often won’t react when when new threats do occur.7 As Herman explains:
“After a traumatic experience, the human system of self-preservation seems to go onto permanent alert, as if the danger might return at any moment.”8
A feeling of safety, the creation of a stable internal baseline, must be practiced by survivors daily. The challenge is that the brain also interprets anything unfamiliar as unsafe. Often, the body’s stress response — after years of captivity with no ability to fight the person perpetrating them — begins instead to attack itself. It’s as if the nervous systems of incest survivors are caught in a constant state of tumbling, without knowing that the sand exists beneath us to find relief, as if we never actually learned what safety is, what safety feels like, what safety should be.
After years of developmental trauma, the familiar that felt safe was managing the chaos of incest, while the work to liberate and the peace to be well felt so foreign. So, while I was teaching my brain to feel safe, I was also fighting for it to let go of the home it had known, as well as find and feel comfortable in the unknown, or at least tolerate it. After a few weeks and lots of tests, Dr. Jeanette finally diagnosed me with:
Anxiety Disorder
Major Depressive Disorder
Obsessive Compulsive Disorder (OCD)
Post-Traumatic Stress Disorder (PTSD)
Attention Deficit Hyperactivity Disorder (ADHD)
She reminded me that the incest abuse was not my fault, but that healing was my responsibility. That my brain could change through a process called neuroplasticity, and that many of my symptoms could cease. If I invested in the work to heal, then I would get well. She also recommended I see another therapist simultaneously. Dr. Jeaneatte wanted our focus to stay in processing the past, but I still needed support to manage the debilitating difficulties of my life in the present.
So I found another therapist, whose name also happened to be Anne. She worked at a preschool, so toys and a sandbox covered her therapy office. Together, we played with characters and symbols, myths and metaphors. Through play, Anne could access my inner screamer. Non-verbal, this part of me needed different tools to communicate, so instead of words we used colors and coordinated dolls, sounds and symbols, helping my inner screamer to shape sense around her own experience with the tools only she had access to. Anne, knowing how expensive treatment was for survivors, charged me only $5 per session.
Still the work rarely felt worth it and suicidality still tempted me. Day after day, I knew what I was recovering from, but with all of the disillusionment of the reality of adult life, I couldn’t help but wonder:
What was I recovering for?
Morning came and I arose and drove to the high school to work like I normally did: sleepless, tired, and uncertain about how I would make it through the day. There were two cars far in front of me: an SUV and a crossover. Suddenly, a sedan ran the stop sign on the street perpendicular to ours and crashed head on into the SUV. The crossover then rammed the SUV from behind, spun into oncoming traffic, and finally stopped at the curb across the street.
As the sole witness of the accident, I pulled over immediately. First I called my school to tell them I’d be late, while running to the white car. Through the window, I saw a young woman: her lower body still sat on the driver’s side, while her upper body laid straight across the passenger’s seat. It was clear to me that she had died on impact. I checked the passenger door to see if I could open it. It was locked.
There’s nothing you can do for her.
While I called 911, a young girl in a plaid uniform skirt that showed she was a student from my school exited the crossover across the street. I ran to her. She recognized me, threw her arms around my shoulders, and called me by my father’s last name in a tone that said, “Thank you for being here.”
As the ambulance and police arrived, I approached the girl in the SUV, who also happened to be wearing a uniform skirt from my school. She froze in shock and said nothing. The dispatcher called me over. With fumbled words, I tried to explain what happened:
“The white car just flew out of nowhere and hit the black car.” The student in the CRV had a different story so naturally, I became uncertain about mine. But that image melded into my mind: the visual of a sedan running a stop sign and ramming into the SUV. The image of a young woman sprawled across the passenger seat.
Eventually, I learned that the woman in the white car had, in fact, died on impact. She was 24 years old, the same age as me. Instantly, it was as if a switch flipped in my body. My desire to fight for my life reignited. That flame that continued my prayer in Lourdes lit once more. I went to work shaking. My principal gave me the rest of the day off. Immediately, I called Father Matthew. We couldn’t sit in the garden of the Peace House in El Salvador, but we could still meet face-to-face virtually.
“I watched a woman my age die,” I cried.
“I’m so sorry, Anne. Are you okay?” He asked compassionately.
“I can’t make sense of this experience,” I explained. “I was thinking about ending my life and watching her die changed my mind. I don’t believe that everything happens for a reason, and I don’t want to glorify her death to make sense of this new life within me. I don’t know what to believe.”
“Anne,” Father Matthew began. “I also believe this didn’t happen for a reason, but her death didn’t need to go to waste. It sounds as if you were there to receive her life’s energy.”
~ ~ ~
I sought more healing modalities like Cognitive Behavioral Therapy (CBT). However, I quickly suspected that the practices the therapist taught me were actually just encouraging me to pretend I was okay: to try and be anxious “later in the day,” to practice normative social behaviors even if they felt unnatural to me, exhausting to me, or even harmful for me.
“You have to do the work!” The therapist demanded.
“The work isn’t working,” I replied.
As my healing process plateaued and symptoms continued, I found research that proved the efficacy of clinical PTSD treatments had also stagnated and were only known to be suitably effective for two-thirds of participants who have access to care.9 Although some primary therapeutic practices were helpful for adult-onset trauma, those same tools were significantly less helpful for childhood-onset trauma.10 For survivors of various sex crimes, many methods of psychological trauma treatment (e.g. CBT, EMDR, etc.) were effective for only 50% of those who have PTSD.11 As a child-onset, serial sex crime survivor, I was one of the 50% of patients who had access to care and treatment-resistant symptoms.
The diagnosis I came to find that best suited me was called Complex-PTSD.12 In 1992, Judith Herman proposed it as a distinct diagnosis for people who have experienced serial violence over long periods of time. Although similar to PTSD, it had different symptoms and needed updated solutions. But the condition has yet to be added to the DSM-5, officially limiting believability, research, and training on the subject. Besides, many survivors challenge the language of “post-traumatic stress.” For those of us who suffer continuously due to social injustice and neglect, the trauma never actually ends, but changes. Everyday, we’re constantly managing the consequences of complex trauma. So I stopped trying so hard to fix myself and shifted my focus to finding myself, discovering some sort of life that actually felt worth living.
Morrison, Toni. “The Connecticut Forum: In conversation with Frank McCourt and moderator Juan Williams.”
Herman, Trauma and Recovery: The Aftermath of Violence--From Domestic Abuse to Political Terror.
Vickerman and Margolin, “Rape Treatment Outcome Research: Empirical Findings and State of the Literature.”
“Intra-familial child sexual abuse.”
Summit, “The child sexual abuse accommodation syndrome.”
Olafson, Corwin, & Summit, “Modern History of Child Sexual Abuse Awareness: Cycles of Discovery and Suppression.”
Van der Kolk, The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma.
Herman, Trauma and Recovery: The Aftermath of Violence--From Domestic Abuse to Political Terror.
Bryant. “Post-traumatic stress disorder: a state-of-the-art review of evidence and challenges.”
Van Der Kolk et al., “A Randomized Clinical Trial of Eye Movement Desensitization and Reprocessing (EMDR), Fluoxetine, and Pill Placebo in the Treatment of Posttraumatic Stress Disorder: Treatment Effects and Long-Term Maintenance.”
Vickerman & Margolin, “Rape treatment outcome research: empirical findings and state of the literature.”
Herman, Trauma and Recovery: The Aftermath of Violence--From Domestic Abuse to Political Terror.