Traumatic Times
 
DR MARIA SCODA
 
Reproduced from Connection, the newsletter of Encompass Australasia (March 2005)
Available for download from http://www.encomp.org.au
Encompass Australasia: Enhancing psychological and interpersonal wellbeing
and vitality through professional assessment, treatment, renewal, education and research.


 
People all over the world have been at a loss for words after the devastating impact of the South Asian Earthquake and Tsunami. It has been difficult to comprehend the overwhelming number of lives lost as well as the staggering number of people injured and displaced.
 
Feelings of disbelief continue to be present in many individuals, particularly in those who have been directly affected in one way or another. They may experience profound distress and grief reactions, which could show up immediately or many months later.
 
Some of us people of the South Pacific have family members and friends who have died or have lost their homes and livelihood as a result of the natural disaster. These people may also have to deal with reactions of grief and stress. Others who are less directly affected but who have witnessed what happened on television or read about it in newspapers may also find themselves feeling uneasy as they call to mind memories and feelings about painful or violent events that they might have experienced in the past.
 
Research has indicated that many people have been exposed to some type of trauma in their lives. Being a victim of, or witnessing an event that threatens death or serious injury can cause traumatic reactions in people. An event that threatens the physical integrity of self or others can also be traumatic. Such events include, but are not limited to, natural disaster, serious injuries, combat, assault, sexual abuse, torture and sudden loss of a loved one.
 
Traumatic events can shatter our basic belief that the world is a safe and secure place. There is no one way to react to a traumatic event as there is a strong subjective component in people’s reactions depending on a range of things, including a person’s temperament, thinking patterns and whether they have experienced other traumas. Despite this, research has indicated that there are some common patterns in how people can react to trauma.
 
Emotional Reactions: These include feelings of fear, panic, worry, shock, numbness, denial, guilt, anger, sadness, grief, helplessness and confusion.
 
Cognitive Reactions: These include forgetfulness, difficulty in making decisions, blaming others, being more or less alert, difficulty in concentrating, seeing the event over and over and avoiding feelings.
 
Physical Reactions: For example, people may experience headaches, fatigue, edginess, insomnia, nausea, stomach-ache, diarrhoea, back pain, tightness in neck and shoulders and shortness of breath.
 
Behavioural Reactions: Including withdrawal, angry outbursts, changes in food or alcohol consumption, changes in activity level and more frequent visits to doctors for physical complaints.
 
Increased Sensitivity: For example, increased hypervigilance and being more easily startled. Interpersonal Changes: These can include loss of intimacy, being over-controlling, work problems and conflict and distrust with others.
 
These symptoms can come and go and are likely to vary in intensity and duration. Although traumatic events can provoke such feelings and reactions that feel uncomfortable and can upset and distress us, it is important to remember that in most cases, these are normal responses to abnormal events.
 
At times, people may be able to use their internal resources and strengths to gradually work through their feelings and reactions. Although very painful, trauma does not necessarily have to be disabling.
 
A number of coping strategies have been identified to help people get through distressing times:
 
• Accept that you are likely to have an emotional and physical reaction.
• Give yourself permission and time to feel upset and grieve.
• Don’t isolate yourself
• Talk to others you trust about your feelings. Sometimes talking with others who have been through a similar experience can help.
• Try not to minimise or hide your feelings and trust that if you cry it is normal.
• Allow yourself to accept support from others. Remember that people do care.
• Don’t make any major life changes or decisions.
• Set small realistic goals to help you reestablish familiar routines.
• Don’t be overly active and take too much on.
• Ensure you get enough rest as well as physical activity.
• Eat nutritious meals and avoid alcohol and other mood-altering substances. Numbing your feelings with chemicals will put off the recovery process.
 
Although the memory of the experience will remain with you it will be important for you to try to integrate this memory as a part of who you are now.
 
However, some people have found that they are unable to regain control of their lives and their symptoms do not settle. The most common diagnostic category used to describe such a deep emotional wound is Posttraumatic Stress Disorder (PTSD). The symptoms of PTSD comprise of three main categories:
 
Intrusive Symptoms: The traumatic event is re-experienced in the form of nightmares or vivid daytime memories, or in flashbacks, which may occur suddenly and without obvious cause. This is because traumatic memories remain stored near the forefront of awareness and can be easily triggered. Cues can be obvious or subtle and they may trigger most of the memory or just certain parts of it. Cues can come in many forms including: sound (e.g. a loud bang reminds one of the sound of a gunshot), sight (e.g. seeing someone with particular facial features reminds one of the person who sexually abused them), taste (e.g. eating potato reminds one of being forced to eat food off the floor when young), smell (e.g. the smell of aftershave reminds one of being sexually abused), touch (e.g. being held in a particular way reminds one of being abused), significant dates (e.g. anniversary dates of the trauma) and a news story of a similar event.
 
Once processed like normal emotions, logically and verbally, traumatic memories may then be filed away and recalled without overwhelming emotion.
 
Avoidance Symptoms: Given intrusive symptoms can be very uncomfortable the person suffering from them may try to avoid situations, people, or events that remind them of the traumatic event. Another way that a person can try to avoid painful memories and feelings is through dissociation. Dissociation can be a useful coping mechanism used to numb overwhelming pain and distress.
 
However, continual use of dissociation is less helpful because it prevents the healing process and leaves one feeling tired and irritable because of the enormous amount of energy it requires. In addition, in numbing out painful feelings we also block out pleasant feelings. Dissociation is more likely to occur if the trauma was severe, repeated or occurred at a young age.
 
Arousal Symptoms: Overwhelming trauma can cause individuals to feel at risk for further trauma and as such, the nervous system becomes very sensitized. Under these circumstances, the body can experience extreme general physical arousal and the nervous system overreacts to even small stressors. Research has shown that a traumatic event can change the function and structure of nerve cells.
 
Signs of arousal can include difficulty sleeping, twitching, irritability, anger outbursts, difficulty concentrating, hypervigilance (anticipating disaster, rapid scanning, being overprotective or over controlling), elevation of certain stress hormones, elevated heart rate and blood pressure, hyperventilation and lightheadedness.
 
Risks Factors associated with PTSD: A person’s risk for developing PTSD can increase when other factors are involved, including that they have experienced multiple traumas and that they have had other psychological difficulties as well as if there is an absence of a support system in their life.
 
It is important to note that individuals with a history of trauma are at a higher risk for developing other psychological health problems including depression, anxiety, panic attacks, phobias, alcohol and/ or drug abuse, problems with identity, problems with self-esteem and problems with physical health. Over time, these secondary problems can become more disabling and more difficult to manage than the original PTSD symptoms. It will therefore be important to seek help for these concerns as well.
 
In addition, sometimes helping professionals may need assistance in dealing with a phenomenon referred to as secondary or vicarious trauma, which occurs through the helper’s exposure to trauma in working with the victim. Their worldview may be challenged and trust undermined and sometimes aspects of the trauma may be re-enacted between the victim and the caregiver through engagement in patterns of trauma transference. The helper in this case may need to have a support system to help them to process these symptoms of secondary trauma.
 
Generally people of all ages can be resilient and are able to recover from trauma within a short period of time. Should the trauma symptoms persist for more than one month, however, people should consider seeking professional psychological assistance as appropriate therapy can assist with the integration of trauma and the return to normal functioning.
 
References:
Schiraldi, G. 2000. The Post-traumatic Stress Disorder Sourcebook: A guide to healing, recovery and growth. LA: Lowell House.
http://w3ouhsc.edu/psbs
http://www.astss.org.au
http://www.rcpsych.ac.uk/infor/trauma.asp
 
Dr Maria Scoda has been part of the Encompass team as a clinical psychologist for three years. She is the Director of the Encompass Continuing Care program and travels extensively to meet with clients and their support groups as well as running the outpatient group in Sydney. She holds a Doctorate in psychology and is a member of the Australian Psychological Society College of Clinicians.

 
TRAUMA SURVIVAL STORIES
 
Amidst the untold tragedy and carnage in the wake of the tsunami, isolated stories of survival despite all odds have emerged as testament to the resilience of the human body and spirit. These include tales of a 6 year old Taiwanese girl reunited with her family after spending 22 hours in a coconut palm on Phuket beach, an 80 year old Indian man who led his family to safety through 10 miles of dense mountain forest, a one month old baby found by her parents floating on a mattress in a restaurant, the Sri Lankan fisherman who clung to his boat for 3 days until he was rescued by helicopter and the Indonesian man found floating 100 miles offshore holding on to a tree branch 8 days after disaster struck, clinging to life despite his conviction that the end of the world had come. There are also the stories of selfless heroism, such as that of the Swedish woman who was photographed running back towards the wave in an effort to rescue her husband, brother and three sons. Miraculously the whole family survived and she reflected that “We came so close to death that we realise how valuable life is” . Similarly another survivor commented “I think we have come to realise what is important in life”. Of course these stories cannot begin to dent the scale of the tragedy and each of these survivors will have their own trauma sequalae to deal with. But they lend weight to the cliche that sometimes adversity brings out the best in one and helps us to refocus our lives. Sometimes too this process of refocussing can be a means of processing trauma as people are able to make new meaning out of what has happened - either through honouring it in their lives in some way or viewing it as a catalyst for change. For example Harold Kushner, a Jewish rabbi, wrote the book ‘When Bad Things Happen to Good People’ after the death of his son, in which he shares some of the wisdom he gained from this tragedy. Of course he would rather his son had not died, but nevertheless he is able to make meaning of his pain through the insights that it brought him.