Victims are easy to identify — or so we think. We see them on TV each day. We are inundated with injury. Too many terrified people, mistreated people, and survivors of war zones and privation carrying their children and belongings. The images arrive from displaced persons camps, airports, and highways.
Look in the shadows, however, and you will find even more. Those are the second-hand souls, the past sufferers, the ones reinjured at a distance.
The men and women to whom I refer are recovering from Post Traumatic Stress Disorder. Some of them are rebroken by watching or reading about the latest victims and the menacing public statements of elected officials. They shudder at the unpredictability in the air. According to the conservative columnist David Brooks, we are witnessing “a rising tide of enmity” in the USA. Indeed, swastikas have appeared in the public library men’s room of my own suburban Chicago community.
Yesterday’s unfortunates are reminded of their imperfect healing by the incivility and xenophobia around them. Their bodies respond by saying “fight or flee.” A sense of being flooded, overwhelmed — even to the point of collapse — sometimes is not escaped for minutes or days.
Retraumatization of this kind can leave the individual disoriented and dissociated. He may undergo flashbacks of his past: a psychic reexperiencing of the event. At the extreme, there is the loss of awareness of where you are, in what circumstances you are, what age you are. You time-travel to a place you escaped, reinstalled into a mental chamber of prior misfortune. Perspiration, nausea, tearfulness, and intense fear are only a few of the possible sensations and emotions.
You are alone, even if others are nearby. The triggered individual is often unable to describe his internal world. He is awash in a fetid river of word-preventing feelings. The proper vocalizations do not come.
What is one to do?
Here is an example of a young man who dealt with a mild version of the problem, but still enough to put him in treatment. He was in his early teens. A bike accident — he was struck by a car — left him with a painful recovery. Even after the physical injuries healed, the newspaper account of the collision — one which blamed him — still felt like an attack. Moreover, the intersection where he had been hurt remained dangerous. He felt both unfairly targeted and helpless to do anything either to vindicate himself or prevent harm to others. He continued to avoid the location, but traffic reports of pedestrian injuries (regardless of where they occurred) darkened his mood and made for painful and repeated revisiting of his experience.
One aspect of his treatment was a turning point. We talked about what he might do to get a sense of control and counter the wrong and wronging newspaper account. This thoughtful adolescent wrote a letter to the reporter who covered the event. Two things followed: 1. His comments were published in the newspaper. 2. The reporter researched the statistics pertaining to accidents at the place of injury and wrote another article detailing the danger. The city council then investigated the matter and made the intersection safer.
Where does that leave you?
You can, of course, hold your hands over your eyes and plug your ears. The avoidance of TV and radio is a close equivalent, as is holding to an agoraphobia-like self-protective self-confinement. Though understandable, these strategies must eventually be set aside lest you continue to remain terror-prone.
Another patient of mine, long after her father died and mother denied (in my presence) that any sexual abuse happened, chose to return to her childhood home. This was the site where years of sexual abuse by dad occurred with mom’s knowledge. She traveled 500 miles to get there. As it happened, the house was being redecorated and the new owner permitted her to look around. My client left the spot with a sense of palpable triumph. She had faced-down the ghost of her demon in the place of his iniquity.
If you are pained by news accounts in the aftermath of the President’s Executive Order of January 27, other actions commend themselves to your attention. The American Psychological Association offered a concerned Response to this Directive on February 1, 2017. It reads, in part:
‘Refugees, particularly those displaced from war zones, experience stress, trauma and other serious mental health problems,’ said APA President Antonio E. Puente, PhD. ‘Denying them entry to the United States, particularly those who have already been vetted, is inhumane and likely to worsen their suffering. This conclusion is based on extensive research and clinical experience … .’
Such policies can lead to a perception of reduced freedom, safety and social connection for those directly affected, as well as for society at large (my italics) … .
Research has documented serious mental health consequences for immigrant children and/or their parents who have been forced to leave the United States, which may magnify earlier trauma experienced in or upon fleeing their country of origin. Sudden and unexpected family separation is associated with negative outcomes on child well-being that can last well into adulthood.
If you have been retraumatized by the human consequences of your country’s immigration policy, your decision concerning any response may be more personal than most. Others, perhaps less impacted in this way, have marched, attended town hall meetings, written public letters to news organizations; and visited, called, or emailed their elected representatives.
In the end, those without trauma histories would be wise to refrain from judging whatever action you choose or do not choose. The world presents many chances to reinvent ourselves and repair the injuries it inflicted.
Remember, however, that you and your therapist aim to help you distinguish the present from the past, both intellectually and emotionally: to realize you can act today in an effective way not possible before. And to keep the past from recurring in any form by your self-affirming assertive actions.
The top photo is a Syrian Refugee and Her Newborn in Ramtha, Jordan taken by Russell Watkins for the UK Department of International Development. The second image is a World War I propaganda poster called Every Girl Pulling for Victory by Edward Penfield, created in 1917. Both are sourced from Wikimedia Commons.
It’s so true Gerald, we are living in such critical times (actually the bible said things would get that bad 2Tim 3:1-5 describes humanity as we see it today ) it’s like the earth is in ICU and the whole of humanity is suffering from PTSD like never before. It’s like our governments are bleeding out of control, money and a sense of future and they don’t know how to stop it and are using crude and callous methods to get things back on track, which as you rightly point out retraumatises people further. I find it so important personally to take each day on its own merits and keep pushing out the past from the present ( therapy helps immensely with that ) and despite everything we see, my faith has taught me that the best is yet to come. Hope for better days is a powerful force for healing as well
I have always been impressed by those, like you, have have a bedrock of faith to sustain them, one that doesn’t crumble in the face of great hardship. Faith can go in many directions, not all of them helpful, but your faith surely sounds like a great comfort to you. More power to you and your faith, Claire.
Getting therapy soon after the trauma occurs can make all the difference in recovery. Unfortunately, this probably doesn’t happen for most traumatized people. Processing and shaping the trauma into a narrative with the help of a therapist can shift the traumatic event from an immediate, sensory experience to one of the past where you have to reach back a bit to feel the pain. Then, hopefully, the triggers no longer unleash a cascade of emotions and images. Still working on that…
Just want to highlight that this actually isn’t supported by the research, and is a dangerous myth that keeps being perpetuated. People need to be left alone to process the trauma in their own way-some will do this through talking family and friends, sport, activism, crying when they need to but focussing on life. After 1-3months those who are clearly not coping/adjusting should absolutely be assessed and offered therapy if necessary, but rushing in to offer therapy straight after exposure to a traumatic event pathologises the natural distress the individual feels, invalidates their coping strategies and disempowers their network fron helping them, making it a ‘problem’ that needs an ‘expert’ to fix. It’s also to do with memory processing and consolidation-in the 24 hours after a horrific event it’s best to get people focussed on small tasks (such as playing tetris). The majority of people who experience trauma will not go on to develop ptsd, and the research shows that when professionals have rushed in to help immediately (as after the Hillsborough disaster in the UK) the incidence of PTSD amongst those exposed was actually increased, for the reasons stated above. Pink
It wasn’t a dangerous myth for me, and others I know–it was life-saving. To be more clear–by “soon after” I do not mean immediately. I consider 1-6 months in that time period, and yes, after symptoms occur. Trauma survivors need support of some kind; it doesn’t have to come from an “expert”. The circumstances of the trauma matter, too. Waiting years to deal with a rape, abuse, or military trauma can make recovery a much harder process. Untreated PTSD greatly impacts one’s physical and mental health, and quality of life.
Evelyn and Pink,
Thanks to both of you. This is a complicated issue. Among the complications are the different kinds of trauma one might be talking about. First, there is a trauma that happens once vs. repeated trauma. Second, one must consider the intensity of the trauma. Third, there is the gender of the sufferer and other personal historical characteristics. Then there is the type of trauma. Just to name a few, we need to include combat, sexual attack, physical injury, life threatening illness, and natural disaster. Add to all these considerations whether one has sustained the trauma oneself (as in a sexual attack) or witnessed it happening to someone else. In light of all that, one can say that most people who sustain or witness the kind of trauma being discussed don’t develop PTSD, as Pink states. They do, indeed, tend to recover spontaneously. Among those who do develop PTSD there is also a high spontaneous recovery rate (consult the linked discussion of a large meta-analysis included below). Evelyn details a number of important considerations as to when to enter treatment. The studies of which I’m aware generally tend either to look at one particular kind of trauma or group impacted by trauma (like combat veterans) or combine many of the different variables I mentioned above. As a consequence one must be careful about guidance to anyone who has sustained a traumatic event as to whether and when to enter treatment. As in the case of many medical and psychological problems, it can be hard to fit one person’s particular symptoms, age, experience, and other factors into the available treatment guidelines. Here are a couple of sites to take a look at on this subject:
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Love this article Gerald-the place where psychologucal knowledge and activism meet. A powerful reminder of the steps we can take when we start to give up. I’ve been so sickened and disgusted by UK politicians recently (our NHS is being deliberately run into the ground so that it can be privatised, refugee children are being refused entry, bloody brexit!) that I’ve felt powerless and hopeless, and turned away. You’ve kicked me up the bum though, reminded me this is the time to stay engaged. I’ll write to my MP today. Thank you Gerald. Pink
Thanks, Pink. I’m pleased that the kick “up the bum” was virtual. I’d hate to be charged with battery!
From my own experience and being close to others, I believe if it’s at all possible, engaging in some kind of creative experience — writing, art, music — is a way to help being engaged once again in life’s possibilities.
Good suggestions, Joan. These are often used in the formal treatment of Trauma and Stressor-Related Disorders (of which PTSD is one), as well.
Dr. Stein, thanks for this timely and sensitive approach to our latest social-political crisis. These are dark days for our nation when we allow our fear and hatred of the Other to trump our understanding and compassion.
Thank you, Rosaliene. To the good, you are one of the people I look to in order to find a candle exposing some of the dark places.
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Firstly Dr G please add to your blog header – this may be triggering – I’m kinda sitting huddled in a corner right now hoping the monsters won’t come out to play
Secondly my apologies for being grouchy but my fuse kinda got lit – your article as usual got my brain cell light bulbs flickering on and as usual you en-circle the entire subject and use your words wisely to create an holistic rounded outness of the subject that puts it all into perspective
But to comment on a comment – people need to be left alone to process the trauma in their own way – I was left alone to process my own trauma, from 6 years old onward – was I old enough to be left alone with my trauma and to deal with it on my own – doubt it – was I able to focus on life – doubt it, I was too busy trying to crawl away from my trauma, life kinda ground to a halt – I really wish someone had rushed in and “invalidated my coping strategies and dis-empowered me and my network from helping them, making it a ‘problem’ that needs an ‘expert’ to fix” and I wish my “problem” had been noticed and “fixed” by an “expert” – unfortunately playing Tetris (even if it was available to me) just didn’t quite help to alleviate my trauma symptoms – cutting myself to bits, bulimia, night terrors, self-hatred, self-destruction, annihilating what was left of me, suicide attempts and the development of too many mental disorders and medication and side effects for life that’s what helped my trauma, that’s what happens when you are left alone to process your own trauma for close on thirty long years
Yes you need time to process it, to find the words to name the horror monsters so that you can call them by name, recognize them and learn to tame them, heal them into submission – but to be left alone to process it on your own – just those words “to be left alone” rip into me – no-one, no matter what their trauma or whether it will make it worse or better should be “left alone to deal with it on their own” – that is of itself trauma – I’m not advocating taking someone fresh from a traumatic experience and dumping them in a psychologist’s office and expecting them to tell all and process it in 5.5 sessions flat – trauma takes time to process and heal – but the person traumatized, from hour one after the trauma needs to know unequivocally that they ARE NOT ALONE and that they do not have to go through processing the trauma alone – a hug even a number to call for a trauma center when you are ready to talk is much more validating than being told to go play tetris
What I do take away from this Dr G is what you write: “The world presents many chances to reinvent ourselves and repair the injuries it inflicted.” and “to realize you can act today in an effective way not possible before. And to keep the past from recurring in any form by your self-affirming assertive actions.” this gives me so much hope and determination and healing possibilities and that as you say I can and will keep my past from reoccurring by learning and implementing self-affirming and assertive actions – the past is not my future and unlike my past I carry hope with me in my present and my future
Apologies Dr G for hijacking your blog once again, I am now off my soap box, I might even go and investigate a game or two of tetris 🙂
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No need to apologize, Rosie. You’ve added something worthy to the conversation. Two points. First, on the subject of a “trigger” warning, I am sorry that my essay contributed to putting you in the corner. The problem for me about a trigger warning (which some bloggers do use, as you are aware) is that I would be suggesting I know with some confidence which of my posts might trigger someone and which might not. I thought a good deal about how to entitle this essay and settled on the title I gave it, believing the words “trauma reminders” and “intrude” would convey the same meaning without telling people with certainty that this would be safe or unsafe. Obviously, that wasn’t sufficient, but I’m still hesitant to get into the habit of using the words “trigger warning,” because they may set some people up (when I don’t use the words “trigger warning”) to walk into a post and get knocked over (pun intended). That doesn’t mean I’m not sorry for your upset. I mean to say I haven’t come up with an adequate solution. Second, your point about needing someone to come to your aid as a child with post traumatic stress is an essential one. I’d add that psychological problems are often normalized in our society. Even adults don’t often know whether their internal experience matches that of others or is out of the bounds of normality. We do need concerned others, especially those in positions of intimacy or who have been assigned jobs of “protector” (like teachers) to make an effort to intervene if they see signs of trouble. Thanks again, Rosie.
Good to see you tackled this subject in your own time; not every white man cares to. And I’d like some info on dealing with fragments of trauma. Not full-blown retraumatization or even an overt trigger, but personal tendencies and sensitivities that can linger even after memories are processed and the reintegration of the self is well underway. It’s the little things, as they say. And they can be maddening to unearth.
How could I not deal with the issue, white man or not? That, at least, was how I looked at it. Two thoughts on your question of “sensitivities” as I understand it: one, to make a practice of meditation, which creates a mindset of “noticing” events and experiencing them, without evaluation. Second, to gradually approach the situations which tend to trigger those sensitivities until they are more normalized. Thanks for your comment.