TRAUMA – A wound to the soul

I regularly talk on radio programs with regards to mental health issues. On one such weekly program I invited my dear friend and colleague, Jeanne van den Bergh, to speak on the question: “Why me?” Jeanne is a specialist therapist when it comes to the topic of bereavement. She is daily confronted with this specific question, especially in times when persons are regularly affected by critical and life changing events. Our conversation gradually moved to the impact and effects of trauma on a person’s being.

Our wholeness as human beings is constructed of various factors contributing to who I am. To only mention a few: the biological, psychological and spiritual person who is also in constant reaction with the environment or context such as significant others, culture, intellect, social and economic dynamics. We are in constant process and transaction with ourselves as well as the context we find ourselves in at any given moment. According to these relationships with the self and the environment we construct certain meaning and perceptions with regards to ourselves as well as the world we live in.

Some events in the environment could make total sense to the person, the self find the experience to be congruent and integrates the experience into the structure of self. Other experiences might be of no significance and the person would not attach any meaning to the event, the experience is thus ignored and not integrated into the self as construct. An unpleasant experience that does not make sense or is not congruent to the concept of self is most likely to be integrated on a distorted manner into the self. I can, in other words, not associate myself with what happened to me and now ask the question: Why me?

In the context of Trauma we first need to give attention to the event that causes a person to struggle to make sense of what happened in their lives. We tend to generally refer to the event as trauma: “I have been through a lot of trauma…”  What the person is referring to is actually a Critical Event; trauma as such is the biological and psychological reaction on the event. I will use the example of a person accidentally cutting his/her hand, the knife cutting through the skin into the flesh is the actual event, the shock reaction and gushing wound would then be the actual trauma caused by the knife cut. This cut might even leave a scar. The form of the scar and the way the person creates meaning of that scar depends on the medical as well as psychological treatment that forms part of the healing.

The critical event is thus an event or situation that causes great emotional and sometimes physical agony and disruption, also referred to as the traumatic event. As explained above the trauma reaction to a critical event can be explained as an emotional wound or shock that creates substantial, lasting injury to the psychological self of the person. People might experience that they are not “coping”. They were not prepared for the event that disrupted their lives. At times persons are prepare to deal with a crisis. Coping would rather refer to a person’s ability to function or manage under traumatic/crisis situations, danger or threat to the self of an individual.

Sometimes we are not prepared of what is happening around us and the perception is experienced that "I am not coping". The feeling of not being prepared, in control and not being able to cope contributes in the difficulty to create meaning of the event. The person experiences that everything including their lives is in crisis, the wholeness of the person is affected and the person could even start questioning his/her own existence.

A Crisis can be defined as an unexpected disruption to the usual route of events in a person’s life. As we are unique individuals, the manner in which we react to a disturbing event would differ from person to person. The extent of the crisis is held according to the person’s unique experience of the event. A crisis should thus always be understood from the individual’s frame of reference.

The person could react by re-evaluating his/her own feelings, thoughts, judgement and behaviour. General crises could include having a unwanted baby, losing a job, death of a loved one, getting divorced, being arrested or relocated, experiencing a traumatic event such as a hi-jacking or motor vehicle accident. Trauma, the reaction to the critical event, is a highly distressed, but not essentially unhealthy emotional reaction experienced by persons as result from exposure to a crisis or traumatic event. Trauma refers to the emotional reaction and not to the event itself.

Examples of traumatic events include human or man-made disasters, violent crimes, motor vehicle accidents, and human rights abuses. When a human being experience, witness or have to deal with a critical event related to actual or threatened death, serious injury or threat to physical integrity of the self or others. The person could act in response to the event with extreme fear, helplessness, dreadfulness or horror.

Persons might even experience Multiple Trauma that is an emotional condition experienced by persons who experienced series of similar traumatic events. For example, a person who has experienced several armed robberies or emotional/physical abuse would be at risk of presenting with signs and symptoms of recurring trauma. Traumatic events include once off event where a person is exposed to only one traumatic incident as well as multiple trauma where a person is exposed to more than one category of distress. The symptoms and interventions required with multiple trauma might present more complex than in single traumatic experiences.

Psychological Trauma is a form of harm to the mind that takes place as a consequence of a brutally painful episode. When trauma reactions are left untreated the condition might develop to a diagnosis of posttraumatic stress disorder. Consequent harm may involve physical changes the brain and chemistry of the Central Nervous System (CNS) and would affect the person's response to future stressful events. In short TRAUMA can be defined as: WOUND TO THE SOUL (Greek).

We all would react differently to a traumatic event. The event could relate to a once off experience, continuing or recurring event(s), that fully:

·         Overpower the person’s capability to cope or integrate the information and emotions associated with the event experienced.

·         The perception of being overwhelmed maybe delayed for days or even lengthier periods and the person could struggle to cope with the immediate demands or needs. Persons would seem to not be able to cope with daily stressors and challenges.

·         Psychological trauma can also result in severe long-term depressing consequences that should not (never) be ignored.

After a traumatic experience persons might present with the following:

·         Re-experiencing the trauma psychologically and physically. Persons will avoid reminders or triggers associated with the event. Reminders might be emotionally uncomfortable and agonising. No one of us and even the human brain wants to be reminded of a painful and heartbreaking event.

·         Psychoactive substances such as alcohol, drug and medication abuse can occur as the person to try to numb the uncomfortable feelings. The person is thus “self medicating” the trauma symptoms. It is advised to rather stay away from any form of psychoactive drugs that is not prescribed by a medical professional. Self-destructive coping mechanisms such as chemical substance abuse may be an effort to “self-medicate” and the person might not be fully conscious what it is that cause the behaviour.

·         Re-experiencing symptoms are an indication that the physical and psychological self is making an effort to cope with the traumatic experience. The brain and whole person is attempting to make sense of an event that has no meaning at all.

·         Triggers and reminders of the trauma could result in anxiety and other associated emotions. Persons could also be unaware of what triggers or reminders might be. They would become aware that they are constantly anxious or anxious in certain situations that reminds them of the painful event. Panic attacks and constant anxiety indicates psychosomatic reaction to emotional reminders or triggers.

Intense feelings of anger, annoyance or outbursts may present frequently. The affect might be experienced in inappropriate and even unexpected situations. Persons could further experience that danger may constantly be present or lurking. Horror from past events is experienced in the present. In other words, the past intrudes in the present moment and can cause havoc in the person’s internal and external world. Traumatic events can then continually be experienced as if happening in the present. Re-experiencing the event prevents an individual constructing perspective of the traumatic experience. Disturbing reminders such as descriptions, images, feelings and flashbacks may pre-occupy the person. Nightmares could be common. Insomnia may occur, “prowling fears" and anxiety results in the person remaining vigilant and constantly aware of danger at all times. Memory loss of what happened during the traumatic event can also occur. Emotions experienced at the time of the trauma may be (re)experienced and the person might not understand why.

The above can result in prolonged episodes of heightened arousal interrupted by periods of bodily and psychological fatigue. Emotional tiredness and exhaustion may set in and distraction is commonly observed. Clear thinking, judgement and assessment of everyday situations may be difficult or even impossible for the person. Emotional detachment from the event as well as dissociation from the own self and context can be regularly present. Emotional distancing from the pain, feelings, reminders, places and emotion consist of “anaesthetising” all emotion. The person may appear: psychologically dreary, worried, anxious, preoccupied, isolated or emotionally cold. The person can become bewildered in everyday situations and report difficulty with regards to memory and concentration.

Several traumatised persons may feel permanently damaged when trauma symptoms are not addressed and understood. Others feel that they would never see the world as a safe place to be and experience feelings of misery, sadness, constant unhappiness, melancholy, despair, no self-esteem and often depression.

In this discussion I have not gone into the detail related to the biological reactions to a horrific experience. The person as a whole reacts and the chemical reactions in one’s brain and body are enormous and could not be limited to this discussion.

If significant characteristics of the person's self and perception of the world have been violated, person’s may call in question their own identity and sense of meaning. No matter the nature of the critical event, the trauma reactions the person is presenting, there is always a human being aiming to make sense of his/her own existence. Behind every condition, diagnosis and even symptoms, there is a human being present. That person seeks to be heard, to be understood, but most of all... we all need to know that we will be okay. We need to realise that we do have control and are able to survive and re-construct ourselves, at least there must be someone unconditionally believing that I would be able to gain the inner strength and human potential to heal.

"Too often we underestimate the power of touch, a smile, a kind word, a listening ear, an honest compliment or the smallest act of caring, all of which has the potential to turn a life around."
Leo Buscaglia

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