The Legacy of Trauma: Unhealed wounds

The Legacy of Trauma:  Unhealed Wounds
By Gary Reece, Ph.D.

We have witnessed another large scale traumatic event which in its concentric circles of victimization will traumatize not only individuals, but an entire community.  Aurora Colorado gets added to the list of unbelievably tragic events:  Columbine, Oklahoma City, Virginia Tech, 911, Tsunami, all are recognizable by just a word or letters.  What is not understood is that those who were the first responders also are impacted because they are “tough, highly trained professionals just doing their jobs.”  First responders after all of the events cited above have higher levels of addiction, depression, suicide, and failed marriages than ordinary citizens.  Why?  Because of the seldom recognized  and little known reason that they are terribly affected by what they do.

They are more vulnerable to trauma effects than the other victims because they are exposed to a high level of blood, horror, and devastating wounds they are expected to cope with.  We call them heroes, and they are, but that appellation does not immunized them from what they experience in the trauma scene.  They will be haunted by what they saw, smelled, touched, and waded through in their initial response.  They as well as all other victims are endanger of ending up with unhealed wounds.  The legacy of incomprehensible terrorizing, horrifying violent attacks against our humanity, communities and collective psyches is the very real danger of lasting and crippling wounds.  The first responders I have worked with are also in danger because of a culture of machismo which leads them to believe they should be “strong and invincible” unaffected by the events because to feel and be hurt by what they have participated in would leave them feeling like the rest of us: vulnerable and fragile, so they say they are “fine” and function right through the pain and horror.  It is only later that they are not fine.

The risk of these horrific, violent kinds of trauma, is that all affected become stuck, or frozen in time. An unhealed wound is by definition a failure or distortion of  the tasks of mourning and healing of psychic wounds due to trauma.  This failure to grieve a loss, this failed resolution can happen at any stage in the recovery process.  Another risk is secondary trauma, which can be attributed to insensitive media members violating the privacy of victims in their race to cover the event.

Recovery involves essentially 4 phases.  The first stage is Recognition.  The primary symptom of being stuck in this stage is either numbness or a total absence of feeling.  This is the residual of shock with feelings of unreality:  victims often remark that it felt “surreal, as if it wasn’t happening.” This is because the event is too overwhelming:  our psychological defenses cannot process that level of feelings all at once.Trauma by definition is an overwhelming experience that renders us shocked and helpless.

If healing is to take place it must be Recognized and the victim must find a way to work through denial and numbing.  This cannot be done all at once or merely a superficial, Yeah, it happened and I moved on.  This is still denial.  The worse the trauma the longer it will take to begin to feel and process what happened.  The risk at this stage is to our ability to feel anything, to  remain in a state of emotional deadness.  At one event I participated in, I did a critical incident debriefing  with a team of first responders to a plane crash at an airport.  One of the responders recounted that he couldn’t get the smell of the burned bodies off his skin and found himself taking a dozen showers.  Others reported similar experiences and found it helpful to talk about it together.

It should be stated that all of our reactions to unspeakably  high levels of violence are normal reactions  to abnormal situations.  This leads us to the second stage of mourning:  Recall, remembering.  This is when the very appropriate feelings of sadness, rage, emptiness, horror, confusion, regret, guilt, and failure begin to surface.  It is not uncommon for individuals to get stuck at this stage.  I have talked to individuals who walked around for years after the event stuck in rage.  They just can’t get past it.  Others become perpetually sad, their grief is worn like a second garment.  It becomes a part of their every waking moment.

Remembering and recall are critical to recovery because without them their can be no healing.  In order to heal we must be able to remember what happened, but not only remember but to recall and experience the feelings associated with the traumatic losses and residual effects.  This is what it means to grieve.  To permit ourselves to acknowledge the loss in its stark reality and work through all the difficult feelings.

This sets the stage for the next step.  Reconciliation.  What I mean by this is to actively work through the entire event and make sense of it by dealing with all the conflicting feelings and ways in which the event shatters our  beliefs and assumptions.  These events are horrific and shatter our view that life is orderly, just, safe, and meaningful.  When an insane person walks into a theater and begins shooting, this violates all of our assumptions about life and shakes our foundations.  We don’t feel safe, we fear for other acts of violence, we realize our vulnerability and go into a frenzy of trying to make ourselves and communities safe from random acts of violence and realize that we can’t because it keeps happening.

There is no timetable for mourning.  The myth that time heals all wounds is just that, a myth.  We all deal with loss in our own individual ways and each person experienced the event uniquely.  And because of this the task of rebuilding and reattaching is done at an individual’s own pace depending on how they were affected, what was lost, and their own resilience and community resources.  And it must be said that recovery depends in large part on the quality of the recovery environment.

In a community wide event, the entire community must come together and mourn collectively and be aware of the risks of mass tragedies.  Because we exist in community and our attachments to that community are what make us human it is critical that community leaders recognize the power of community in healing and that individuals not try to heal alone.  It is always inspiring to me to see the impromptu memorials which sprout up as if by magic at the site of the tragedy.  Rituals can be powerful ways to collectively mourn.

There are many signs of unhealed wounds.  Some things to watch out for are:

1)  A tendency to be hyper sensitive or to over react to anything having to do with the event.

2)  Restlessness or inability to relax and the need to be compulsively busy.

3)  Fear of recurrence and feelings of vulnerability.

4)  The tendency to over idealize the dead and enshrine them, remember they were human just lie us.

5)  Rigid, compulsive, ritualistic behavior that takes over your life.

6)  Persistent thoughts and preoccupation with elements of the loss.

7)  Blocked emotions,  Inability to feel or a constricted range of emotion.

8)  Inability to talk about anything related to the loss/avoidance.

9)  Relationships marked by fear of intimacy and fear of future disappointment.

10)  A pattern of self-destructive behavior or risk taking.

11)  Development of reliance on substances or abuse of medication.

12)  Chronic experience of numbness, alienation and isolation.

13)  Chronic anger, depression, irritability, intolerance.

14)  Total absence of mourning.  Acting as if nothing happened.

15)  There is a very long list of bodily symptoms:  insomnia, weight loss,
        anxiety,  and stress related illnesses.

The question I am most frequently asked is, “but why do we have to dwell on it?”   “Why don’t we just put it behind us and move on?”

Answer:  Avoidance leads to further complications and unhealed wounds.  Grieving is hard work, but necessary to restore our broken relationships, shattered communities, and wounded minds and souls.  We heal through the process of courageously facing, exploring, feeling, and talking with others.  We make sense of what has happened, face the insanity and meaninglessness of horrific violence and embrace our humanity.  In so doing we affirm the power of love and healing in our relationships with each other.

Trauma: Hidden Epidemic

Trauma:  Hidden Epidemic
By Gary Reece, Ph.D.

     Loss, disappointment, failure and grief are normal and natural accompaniments to the human experience.   Bereavement, the response we have to grief and loss is also familiar to most of us. However common loss is, few of us have learned how to deal with it well. There are many types of loss. There are losses that occur due to normal passages in life, changing jobs, losing jobs, divorces, children leaving home, aging etc.  These also leave scars and contribute to the cumulative effect of life stress.  With each primary loss there are also secondary losses.
      Some losses are the unavoidable results of the human life cycle.  To live is to experience loss.  Most losses are survivable and individuals move through them and restore balance to their lives.  It is estimated by one expert that there are approximately 2 million deaths a year in which 8 to 10 people are affected.  This means that there are as many as 16-20 million new mourners every year.  This expert also notes that at least 1/3 of these individuals will suffer the consequences of complicated mourning, or in other words fail to fully recover from the loss.
      There is another class of loss, however, which presents even greater risks and challenges: Traumatic Loss. In the past decade we have experienced an amazing number  of catastrophes. These catastrophic events have left survivors by the millions with traumatic effects from which they might never recover.  Several come to mind.  We can start with 911, then in random order others spring to mind, Oklahoma City, Colombine, Katrina Hurricane, Joplin Missouri tornado, the Japanese earthquake and tsunami and Haiti earthquake.  Then add wars and civil unrest to the discussion:  the Mid East events: Libya, Syria, Egypt, Iraq, Pakistan, Afghanistan, the genocide in Africa and global terrorism.
This is what I believe constitutes the hidden epidemic, with the epidemic comes its hidden victims.   I think it is because perhaps we don’t think of these as traumatizing events because they are so ordinary, frequent,  and on such a massive scale.  But think of the definition of Trauma.  DSM IV “The person develops characteristic symptoms following exposure to an extreme traumatic stressor  involving direct personal experience of an event that involves actual or threatened death or serious injury or other threats to one’s physical integrity or witnessing an event that involves death, injury or a threat to another person or one’s family or close associates. And the person’s response must involve intense fear, helplessness or horror.  To put it more succinctly,  it is an overwhelming event producing helplessness and terror.  These events are now serial and complex which compounds the effect.
     Clearly all of these events fit the definition, and then add to the list all of the children living in refugee camps, and all of our returning veterans who have experienced events way beyond the definition of trauma and we have an epidemic of unprecedented proportions.  We are in danger of having a whole generation of  victims of severe trauma.
     This is the new age, the new reality affecting our consciousness and perhaps blunting our sensitivities. Can it be possible that through the process of unconscious accommodation that we have become desensitized?   Is this the new normal?
     While the actual experiences of trauma and mourning and its inherent demands have not changed over time, what has changed is the context in which they now occur.  This changed environment is charged with the potential for complicated grief and mourning: unhealed wounds.  The reason for this is quite simple; conditions creating complicated mourning have become more prevalent and wide spread.  Unnatural and violent death is now occurring with less of a social context in which it can be integrated.  The social conditions under which we exist are characterized by increased violence, accidents, terrorism, disaster, holocausts, plane crashes and natural disasters.   The result is victims living side by side, unaware of their wounds. We live in anonymous neighborhoods. Our whole social milieu and dynamic has changed.  Indifference to violence and increased homicide rates in all of our urban areas might reflect this new malaise.        The fort Hood rampage is symptomatic of this unseen trauma effect.
     The loss of the extended family, single parent families, anonymous neighborhoods, and urbanization result in the loss of the experience of community.  Add to this the loss of mental health resources, and the result is more wounded people with fewer resources and opportunities to successfully transition life’s many challenges.
     Lack of resources, lack of awareness, lack of community, and a lack of knowledge regarding the potential harm of living with unhealed wounds leaves many people accommodating to their wounds and living with addictions, depression, fractured personalities, failed relationships, physical health problems, self-destructive behavior, suicide, violence, child abuse and unfulfilled potential.
     I have devoted my entire career as a psychologist to studying and treating trauma and bereavement.  I have experienced many different forms of traumatic loss and participated in many workshops and community disaster responses.  I have also worked with hundreds of victims of trauma.  What I am left with is the awareness of the challenge of raising community awareness, educating individuals to their condition and trying to create opportunities for addressing their wounds.
     One thing I have discovered  in my career is the certainty that it is the quality of the recovery environment which in the long term determines the outcome of recovery. If it embodies the necessary conditions for healing then the outcome is much more favorable.  These conditions are found in the best forms of human community.  Communities bound together by compassion, empathy, intimacy, and trust: and they must also be intentional and bound together by commitment to common values.
     One recent experience led me to understand and appreciate the role a Covenantal Community can play in the healing of persons.  I was called by the Rector of local Church to see if there was anything I could do to help them deal with the sudden loss of two of their most loved members due to sudden death.  I consulted with the Rector and we planned an experience to help the entire community deal with their loss. We gathered in the fellowship hall; shared a meal, and I talked about loss and bereavement and I encouraged them to talk about what they were experiencing.  It was a good time of feelings being expressed, stories told, and sharing of wounds.  Following this experience we went into the sanctuary and took communion.  After the experience, the Rector and I reviewed our experience together.  She stated, “This was the most seamless expression I have ever had of what the original church must have been like.”  That and other experiences like it left me with the conviction that these kinds of shared experience present a wonderful opportunity by the very nature of their structure, values, and founding purpose to be an intentional healing community. At times like this I am  reminded of a quote by Scott Peck:  “It is only in and through community that the world will be saved.”
I will write more about complicated bereavement and PTSD in my next blog.  For those interested you can contact me through my e mail:  gwrphd@verizon.net.  My book:  Trauma  Loss and Bereavement is available by contacting me.