In my capacity as a therapist for trauma survivors, I have spent twenty years listening to people's stories, to the recounting of experiences so nightmarish, so abusive, and so abhorrent that one might well wish never to have known about them.

Then it has been my privilege to know these same people as they recovered from their past experiences, and learned how to live in the present. And I believe that their stories contain meaningful lessons in how to leave behind some of our own long-ago terrors. There are possible solutions that come as gifts to the rest of us from the old souls, the exceptional survivors.

I began my practice by specializing in the treatment of people suffering from medically threatening anorexia and intractable depressive disorders. Also, for better or not, I developed a professional reputation as someone willing to take on individuals who were on the edge, patients whose potential for suicide or other self-destructive behavior had placed them at high risk.

Gradually, I began to notice that, too consistently to be ignored, most of the people I was treating were survivors of extreme psychological trauma, and that their symptoms tended to match the phenomenon of post-traumatic stress disorder just as closely as the more traditional diagnoses.

Sometimes I think of my lifework as overall lessons learned, themes, discoveries. But much more instructively and frequently, I think in terms of the individual human beings whom my profession has brought to me. On a certain level, I feel tied to many of these people with a knot so tight that I readily understand the appeal of notions such as fate, or even karma.

I believe I was drawn to them for their fire. The honest, purposeful sef-examination of a traumatized life creates a heat so exquisite that it burns away the usual appeasements, self-deceptions, and defenses. "What is the meaning of this life?" becomes a very personal question, and demands an answer. Some of the people I have known have burned so fiercely that they have gone all-stop, have quit their jobs, even endured temporary poverty, because answering the question consumed more energy than can reasonably be generated by a solitary individual. There is something electric in the eyes, a little wild.

But paradoxically-and yet, I think, for all the same reasons - these same people often reveal an irresistible sense of humor, an ironic angle on life that has dispensed with the polite and the guarded, and this tends to get right to the core of things. And so, though it may sound odd, when I am with my patients, I laugh out loud a lot.

Many trauma patients are detached and objective when they speak of extraordinary events, such as the particulars of failed suicide attempts, that most other people, if they speak of such matters at all, tend to cushion with lengthy introductions and euphemisms. As I listen to the telling of a personal history, more often than overt "symptoms," it is just such Faulkneresque understatement of the sometimes macabre, along with the burning light in the eyes and the cunning humor, that makes me begin to suspect extreme trauma in the individual's history.

As a psychologist, and as a human being, I am impressed with the irony that these severely traumatized patients, people who have been through living nightmares, people who might blamelessly choose death, often emerge from successful treatment by constructing lives for themselves that are freer than most ordinary lives from what Sigmund Freud, a century ago, labeled as "every-day misery." They become true keepers of the faith and are the most passionately alive people I know.

Or maybe it is more necessity than irony. I have been told more than once by the survivors of trauma that it would not be worth the struggle merely to go on surviving. And that is exactly what most of the rest of us do: we do not choose to die, or to live; we go on surviving. We do not choose nonexistence, nor do we choose complete awareness. We slog on, in a kind of foggy cognitive middle-land we call sane, a place where we almost never acknowledge the haze.

Over the years, what my trauma patients have taught me is that this compromise with reality and its traumas is simply not sanity at all. It is a form of madness, and it befuddles our existence. We lose parts of our thoughts in the present, we sabotage the closeness and comfort in our relationships,and we misplace important pieces of ourselves.