HELPING WITH SHOCK TRAUMA
by Alexis Johnson, PhD
We at CIL are therapists involved in helping others through both normal life transitions and unexpected life events. To that end, we have offered many workshops around the theme of trauma. So we decided to put up this brief outline about trauma to help anyone either understanding his own process or helping others through the aftermath of these terrible events.
Trauma is defined as anything unexpected that breaks our frame of expectations or our frame of reference, events which cannot be assimilated by our inner scheme of self-in-relations-to-the-world. If we have been lucky enough to have established basic trust in the world, trauma destroys it – either forever or for a time, depending on the seriousness of the event and our personal history.
Trauma destroys our fundamental assumptions about the world. In the case of these attacks, all of us have had to reëvaluate our sense of safety. How safe are we? Where are we safe? Who can protect us? How do we protect our children? Most Americans assumed they were safe from terrorist attacks while here – those dreadful things happened in Israel, in Ireland, not here. That assumption is gone, gone forever.
Another fundamental assumption that changes is the value of the self, the value of an individual life. During this event, the subjective individual counted for nothing. Everyone wanted to live, to get out alive. Over five thousand did not have that wish granted. That means that many thousands of living relatives did not have that wish granted. Relatives of those who died will be traumatized and experience many of the things we write about here.
Shock: Almost all of us are experiencing some of the hallmarks of trauma. The first thing that happens is shock, a kind of numbing, a disbelief, this can’t be happening to me, to us; it can’t be happening at all. This is a kind of freezing response. When we need to defend ourselves, we tend toward fight or flight. But, under this situation, we cannot use those defenses. Instead we freeze–both our feelings and our thinking slow down. We cannot focus. We cannot make decisions. We forget things; things loose their meaning. Some of us cry a lot, some cry in waves, some don’t cry at all. Some of us find anger before we find grief and sadness. Many of us have a whole host of emotions at once, all tumbling around inside, keeping us confused, upset, irritable.
Helplessness: This inner sense is one of the hallmarks making an event traumatic. We cannot control the outcome of this event. It has a life of its own, and all we can do is watch. So we watched the buildings fall and the rescue work begin. We listen to the news, to our leaders and our pundits, hoping for wisdom and guidance. If we have clients who lost a loved one, the lesson will go very deep, changing the very fabric of their beings. When the outcome is beyond control, people can give up being their own source of agency and initiation; passivity and depression can feel like the only reality. The mind as a source of ideas and actions can shut down. The will is simply not there.
Anger: For many of us not directly affected by the horrific losses of the terrorists attacks, our response will not be the ‘freeze’ of shock, or the ‘flight’ from danger, but will be the ‘fight’ response. All of us feel the need to do something. Currently NYC has more blood, sandwiches, and volunteers of all kinds than it can manage. Each of us wants to give where and what we can. This all comes from our positive aggression, our need to participate and help. This is not the response of a terrorized person. But it can be the response of a terrorized person if it becomes the only emotion driving the thinking/action part of the being. Anger has a real place in the grief process, but it cannot be the only emotional response from a whole person.
Hyperarousal: This means that the body’s biochemistry is set for fight and flight but there is no place to go and no one to fight! Even people who were not directly affected find themselves jumping at unexpected noises, stopping to listen to helicopters fly over, and unable to tune out things that were, previously, merely annoying. Some become very irritable (also part of the pattern of depression in men). Sleep disturbances abound both in children and adults.
When an individual is in this state, he or she moves from a stimulus to a response without even realizing what has happened. Cognitive functions are moving far too slowly to keep up with biological reactivity. The intense negative emotions of terror, anger, and panic are designed to keep us alive, but under the conditions of trauma, they may be elicited by minor, even irrelevant, triggers.
Under these conditions, the world can become increasingly threatening, and the hyperarousal can generalize to everywhere. Any trivial cue can equal danger. When the autonomic arousal system is chronically in gear, the system loses its function of alerting us to pay attention to a potentially important situation. This kind of persistent, irrelevant firing of warning signals causes physical sensations to lose their functions as signals of emotional states – we no longer have a guide for action. Ironically, our own physiology becomes a source of fear!
We see both extremes. Some people overreact to benign events, becoming hostile and threatening to others. Some react by shutting down, withdrawing into their own inner worlds of helplessness and despair.
Intrusion: If the trauma is particularly powerful, as it will be for those who were directly affected, individuals might continually relive the events as if things were still happening. In their inner world, the biochemistry of shock has caused time to stop. There are no past and no present distinct from the past. Thoughts as both flashbacks and nightmares can occur over and over, as if the dreadful events are happening at this very moment.
The traumatic events are encoded by the stress hormones in a particular form of memory deep in the brain. There are pictures and/or disconnected images. There are frozen sensations in the body. But the frontal cortex is not involved, and that is where we humans make words and, ultimately, meaning of what has happened to us.
Some traumatized people relive the moment of trauma in action. Children can engage in repetitive play that is not creative or open-ended. Adults can consciously or unconsciously reënact the situation (i.e., put themselves in situations for ‘it’ to happen again) or take jobs or tasks which are evocative of the trauma.
Constriction: Often, the overwhelming feelings can fluctuate with a kind of dissociated calm. Meaning is disconnected; emotions are detached. We can have a sense of leaving the body, of going somewhere else, or becoming someone else. This state might be compared to a hypnotic trance. It seems that, when we can’t get away from the upset of the real world, we can at least alter our state of consciousness and get away from being overwhelmed in that way.
Constriction can affect every aspect of our inner life: thoughts, memory, states of consciousness, the ability to initiate, and the ability to create. Some people will now find themselves unable to plan for the future; some will find it meaningless to plan for the future. Some will be unable to visualize any kind of future that does not involve this numbing, overwhelming affect.
Dissociation: All we humans have the capacity to separate ourselves in various ways from the totally of our beings. We feel most whole, creative, and joyful when not separating ourselves, but we have the capacity to do so as needed. Most of us are familiar with the sense of an “experiencing” self and an “observing” self. That is one form of dissociation, and it is most common in the context of trauma. This ability can limit our feelings, specifically pain, plus limit the impact and the meaning of what is happening. As a ‘first response’ to a traumatic situation, it can be very useful. As an ongoing response to life, it can be very detrimental.
The other types of dissociation include the ability to separate:
After a trauma is over in the time sense, it is not over for the individual who has experienced it. Many traumatized people develop very specific symptoms, which we will now briefly discuss.
Somatization: This is the ability to turn overwhelming affect into a physical symptom. Since much of what happened never reaches conscious thought and the linguistic brain centers, we say that the body is left to deal with the problem. These physical symptoms may be highly specific and symbolic of the trauma or may be very generalized and medically elusive. In either case, it is important to remember that they are REAL and must be treated at both the physical and the emotional/spiritual level. For some people, the psychic pain has been declared unfaceable, overwhelming. So it makes sense that the pain has to go somewhere else, in some other form.
Reemergence of old traumas: It is very common for earlier experiences to be reactivated by the current trauma. The brain works by association and by emotional states. This act of violence will remind us of other acts of violence that we have been personally involved with. A previous rape, Vietnam, or any personal experience of danger can be reactivated because of this current situation.
Healing: Iin our experience, healing involves two basic steps: creating a sense of safety in the therapeutic relationship and finding a way to tell the emotional story, the whole story.
As we said at the beginning, safety may never be the same, but that does not mean the traumatized person cannot find rhythms of safety in personal relationships. Moving on after a trauma is usually in a spiral pattern, slowing, building a container strong enough to hold all of the feelings including rage and grief, and accepting that things cannot be undone. History cannot be rewritten. We cannot begin to mourn if we are frozen in the affects of trauma. And mourn we must.
The healing container that the therapist and client co-create must be strong enough to contain all sorts of psychic phenomena: flooding, perceived helplessness, various regressions. For some victims, lots of clinging and regression may be part of the journey as a new inner container is built to hold a new world view and a new view of the self.
Each time a trauma victim goes over the memory, he or she will get a new context for that memory and change that memory. The story will create a new vessel for the self, allowing the story to become a container for who he or she is now, today. At first, the story might be told through enactments or through psychosomatic enactments or through dreams and flashbacks. But through talking and art work and sand trays, the story will take on a new form, a form that can hold a new, sadder, wiser self.
In our experience, catharsis is not a good container for the trauma victim. They don’t need to ‘let it out’. Instead they need to find the pieces, to find the personal meaning.
The procedure called EMDR is very helpful, for it creates a very strong container in the framework of the process and encourages the individual to enter the story through his own mind, seeing it, feeling it, and talking about it–all at the same time.
The telling of the story, with all of the feelings, will re-integrate the person, literally creating connections between the deep brain, which is full of feelings and pictures, and the neo-cortex, where words and meaning are created. The telling of the story will create a rhythm – the rhythm of falling apart and coming together, falling apart and coming together – the rhythm of life as we know it.