I believe that experienced trauma therapists (Think: PTSD specialists) possess an approximate, rather cognitive understanding of flashbacks. On the other hand, I am certain that dissociative disorders therapists (Think: DID specialists) have a much richer grasp of flashbacks, but I don’t think that their richer grasp adds up to a truly rigorous understanding. Not yet, anyway. I guess what I’m saying is that we all probably know less about flashbacks than we think we do. And much of what we do know consists of the hard-won clinical insights of individual therapists — insights that are seldom written down (and thereby made available for general discussion)..
Let’s try to forge a better understanding of flashbacks. This is obviously a very difficult task or it would already have been accomplished. By the way, I, too, find this task to be very difficult.
The Stress of Major Life Events
When I was a graduate student in the early 70s, the Holmes and Rahe Stress Scale was quite popular (Holmes & Rahe, 1967). The scale consists of 43 life events, each with an assigned stress value. The most stressful event is Death of a Spouse (with a stress value of 100). Strikingly, even positive events are stressful (e.g., raises in salary, outstanding personal achievements, vacations). Holmes and Rahe reported that increased stress was associated with an increased incidence of illness.
At about the same time, Mardi Horowitz was studying the intrusive thoughts that follow major life event. Horowitz found that major life events, whether positive or negative, were always followed by intrusive thoughts (about the event). According to Horowitz’ model, these thoughts keep intruding into conscious awareness until the person has cognitively assimilated the event and, ideally, fully accomodated to the event’s personal implications.
Sound familiar? But remember, we’re not talking trauma here. Just major life events. These intrusive thoughts are not flashbacks. They are simply automatic, unbidden thoughts about a big change in your life. Think about: Winning the Lotto. Guaranteed to produce intrusive thoughts for quite a while!
Intrusive thoughts after a major life event are absolutely normal. Major life events always have implications for oneself, one’s future, and one’s place in the world. Consequently, each of these understandings about self and world (and, sometimes, a whole lot more) needs to be recalibrated. Horowitz called this process of recalibration the completion principle. The essential idea here is that intrusive thoughts continue to recur until the person finishes accomodating to the major life event.
Note: The Janet scholars in our midst will note a distinct affinity between Horowitz’ ideas and Janet’s ideas about realization and personification.
In any case, many clinicians have applied Horowitz’ model to flashbacks. Interestingly, many clinicians come to this idea on their own — without having read Horowitz. After all, Horowitz’ model is a very sensible and appealing idea. But, I’m not sure how well the model applies to flashbacks. Maybe yes, maybe no. I’m still on the fence about this one.
The Difference Between Intrusive Thoughts and Flashbacks
Let’s get one thing out of the way. The kinds of intrusive thoughts that follow a major life event are absolutely normal. In fact, I think evolution has shaped the functioning of our neocortex such that Horowitz’ completion principle is built into us. But — there are, indeed, many kinds of abnormal intrusive thoughts.
Good places to find people suffering from abnormal intrusive thoughts? People with obsessive-compulsive disorder. Schizophrenics. People with anorexia nervosa.
In this section of my blog post, however, I am not talking about OCDs, schizophrenics, or anorexics. I am talking about you and me and our normal reaction to major life events — automatic, unbidden, intrusive thoughts about that event until we come to terms with it.
OK. How are flashbacks different from these normal intrusive thoughts? First of all, flashbacks are not thoughts. They are perceptual (imagistic, sensory, and emotional). Thoughts involve both language and awareness-of-the-self-that-is-thinking. Both of these may be lost during flashbacks.
With normal intrusive thoughts, there is always a clear connection between self and the intrusive thought. We own that thought and accept it as mine. The ‘work’ that needs to be done with intrusive thoughts is to fit that major life event — and its personal implications — into our understanding of ourselves and our world. Said differently, we need to accommodate our existing narrative (i.e., our understanding) of self and world to this new information. As we sometimes say about a new idea, “I need some time to wrap my mind around this.”
Flashbacks Exist Outside Language
As humans, we have language and a human consciousness. We live in a narrative world. Our very human existence is inseparable from language. Humans live a narrative existence. That is what it is to be human. We live within language. Flashbacks lie outside language. They are perceptual — imagistic, sensory, and emotional.
Psychologists and philosophers occasionally talk about “raw, sensory data.” But the notion of raw, sensory data is largely a fiction. We don’t perceive raw sensations. What we perceive is already, preconsciously, sorted/arranged into some familiar object or category. We perceive objects and categories — not raw sensations.
I apologize for getting all philosophical on you, but I think this particular point is crucial for understanding flashbacks. Intrusive thoughts come to us already formed into language. Flashbacks don’t. Flashbacks are fragmented images, sensations, and affects. In order for a flashback to finally stop, we must bring those fragments into language. We must develop a narrative of what happened.
OK, this is a good stopping point. What do you think about flashbacks existing outside language?