Recovering from Trauma: What’s Normal, What’s Helpful

by Laurie

in The Comfort Garden: Tales from the Trauma Unit

Last week, bombs exploded at the finish line of the Boston Marathon. In West, Texas, a fertilizer factory exploded. Elsewhere in the country it was trauma as usual: car crashes, gunshot wounds, stab wounds, rape, burns, and on-the-job accidents. In my work as a psychiatric liaison nurse on the trauma unit at San Francisco General Hospital, I spoke with hundreds of survivors and their family members. Here are a few important things to know about trauma and recovery.

In the aftermath of trauma, when the mind and body continue reacting to danger, violence, and loss, many people fear they are losing their sanity. They cannot close their eyes without re-experiencing the scenes they witnessed. They feel confused, their minds race, their hearts pound, their moods swing, and they sweat in the absence of exertion. Breathing is shallow and rapid. People feel jumpy, hypervigilant, and overwrought or they feel numb and detached. Grief is mixed with guilt and anxiety. Parents fear for their children. Children fear for their parents.

All are normal reactions to abnormal events. The best medicine is a combination of self-care and social support.

Advances in neuroscience now demonstrate that trauma resides in the body long past the event itself. That’s why my cousin, Matt, who saw the second airplane crash into the World Trade Center 12 years ago, experienced an electrical surge down his back as soon as he heard about Boston. It’s not surprising that Kaiser Permanente’s ACE study (Adverse Childhood Events), conducted in collaboration with the Center for Disease Control, correlates the onset of many chronic emotional and physical illnesses in adulthood with traumatic experiences endured during childhood.

For a number of weeks after the event, survivors will be primarily concerned with physical recovery, especially when it involves multiple surgeries and taxing physical therapy sessions. In the hospital, psychiatric professionals can provide support by encouraging survivors to express difficult emotions and to explore ways of coping with anger, frustration, sorrow, and fear. They can also teach survivors breathing techniques and lead them through relaxation exercises.

Out-patient support groups with others who have experienced trauma validate and normalize discomforting thoughts, feelings, and perceptions and in so doing, decrease the survivor’s emotional isolation.

Survivors of traumatic events—and caregivers who may be vicariously traumatized–need to be active partners in the healing process. To calm the physiological arousal of trauma, find a quiet, comfortable space and breathe slowly, deeply, and rhythmically at least a few times a day. Some find it helpful to focus on pleasant imagery or listen to relaxation tapes at the same time.

Physical exertion–walking, running, swimming, yoga, tai chi, weight-lifting, dance, gardening, and the like—also mediates the effects of stress hormones on the body, quiets the mind, and re-synchronizes normal body rhythms as does meditation, prayer, chanting, and singing.

While everyone reacts to traumatic events in a unique way, some themes are common to most. In a support group I co-facilitated for three years, survivors often spoke about their post-trauma experiences in the following ways:

“In an instant, everything changes.” People often commented on the cruel transformation from a being a self-sufficient person to one who is dependent on others.

“It’s like a tape playing over and over in my head.” Memories of the trauma scene may flash uncontrollably during the day or startle survivors awake at night.

“If only I had (fill in the blank) maybe this wouldn’t have
happened.” The mind obsessively revisits every microsecond preceding the event, looking for a way it could have been prevented.

“You find out who your friends really are.” Family members and friends are also profoundly impacted by the traumatic event. Some rise to the challenge of providing support and nurture. Others abandon the survivor, fleeing the reminder that life is unpredictable.

“They tell me I should get over it already!” Some survivors feel ashamed when they can’t just “get over it.” Friends and family members may silence victims because they need to deny the fact of randomness in the world. Many feel helpless and fear worsening the trauma by saying the wrong thing.

“No one really wants to know how you are.” Self-conscious about feeling needy and wary of others’ responses to their ordeals, survivors often withdraw from friends and family, causing them to feel lonely and disconnected from others, positioning them perilously close to the abyss of major depression.

Social support cannot be overemphasized. Trauma patients need rides to appointments and religious services, trips to grocery stores and pharmacies, cooked meals, and aid in rearranging living space to accommodate physical disability. Mostly, though, they need our compassion and willingness to listen. Although we can never truly fathom the fact and depth of another person’s experience of trauma, “being with” the survivor (and family members, for that matter)–offering to listen without censorship, without judgment, and without compulsively needing to “fix” them–is hugely beneficial.

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