Trauma
CWC Guide> Trauma

Every year millions of people experience disasters and other catastrophic events. Some of these disasters are due to natural causes-earthquakes, volcanic explosions, droughts, windstorms. Others are due to accidents-airplane crashes, boat sinking, train wrecks, mining disasters, industrial accidents. Perhaps the most tragic of all are the disasters that are the result of conscious human intentions- acts of war, "ethnic cleansing," terrorism, political repression.

When a disaster occurs, the physical consequences are obvious. Buildings are destroyed; workplaces, livestock, and other means of making a living are wrecked; schools and hospitals and power stations are destroyed. The direct effect on the bodies of the victims is equally evident. People are killed or severely injured. The immediate emotional effects-shock, numbness, anger-are also evident. As the days and weeks go by, the physical effects of the disaster may fade. Houses are rebuilt, roads repaired, communications systems restored. For most survivors, the bodily wounds, too, heal. But the emotional wounds-the wounds to the heart, the wounds to the soul-may last.

UNDERSTANDING THE EMOTIONAL EFFECTS OF DISASTER

People experience stressful events on an almost daily basis. Most people, most of the time can cope with these events well enough. But some events overwhelm almost everyone's ability to cope. These extraordinary "traumatic" events-natural disasters, terrible accidents, acts of war and terrorism-share several characteristics:

• The characteristics or the sheer magnitude of the events make them impossible for any one individual to control.
• The events threaten individuals or their loved ones with death or severe injury.
• The events create feelings of intense fear, helplessness, terror or horror.

In many cases (e.g., an industrial accident), the traumatic event is relatively brief. In other cases, (e.g., an earthquake), the event may be brief but the physical consequences may be long lasting and may be a source of as much stress as the initial event. In still other cases (e.g., war, ethnic cleansing), the event may go on and on, a chronic nightmare with no end and no escape.

IMMEDIATE EMOTIONAL RESPONSES TO TRAUMATIC EVENTS

In the first hours or first few days that follow the traumatic events, a variety of emotional reactions may appear. Some survivors may shift from one kind of response to another or may not show a “typical” response or may not seem to show any evident response at all.

• Psychic “numbing”: Survivors may seem stunned, dazed, confused, apathetic. Superficial calmness is followed by denial or attempts to isolate themselves. Survivors may report feelings of unreality: “This is not happening.” They may respond to helpers in a passive, docile way, or may be rebellious and antagonistic as they try to regain a sense of personal control.
• Heightened arousal: Survivors may experience intense feelings of fear, accompanied by physiological arousal: heart pounding, muscle tension, muscular pains, gastrointestinal disturbance. They may engage in excessive activity and may express a variety of rational or irrational fears.
• Diffuse anxiety: Survivors may show an exaggerated startle response, inability to relax, inability to make decisions. They may express feelings of abandonment, anxiety about separation from loved ones, a loss of a sense of safety, and yearning for relief.
• “Survivor guilt”: Survivors may blame themselves or feel shame at having survived, when others didn’t. There may be a pre-occupation with thoughts about the disaster and rumination over their own activities: Could they have acted differently? They may feel responsible for the unfortunate fate of others.
• Conflicts over nurturance: Survivors may be dependent on others, yet suspicious, and may feel no one can understand what they have been through. Some survivors may feel a need to distance themselves emotionally from others and to keep a “stiff upper lip;” they may be irritable in the face of sympathy. Others may feel a strong desire to be with others at all times.
• Ambivalence: Some survivors may show ambivalence about learning what happened to their families or possessions.
• Emotional and cognitive instability: Some survivors may show sudden anger and aggressiveness, or, conversely, apathy and lack of energy and ability to mobilize themselves. They may be forgetful or cry easily. Feelings of vulnerability and illusions about what happened are common.
• Occasionally, survivors appear acutely confused. Hysterical reactions and psychotic symptoms such as delusions, hallucinations, disorganized speech, and grossly disorganized behavior may also appear.

Many of the immediate post-disaster behaviors of survivors have an adaptive quality. The behaviors of the majority of those affected by disaster, even when they seem abnormally intense or entirely unfamiliar, should be understood as normal reactions to abnormal or devastating conditions or events. They ensure short term survival and permit the survivor to take in information at a controllable rate. But the symptoms themselves may be perceived by the survivors as socially inappropriate, as a source of shame, guilt, and failure, as an evidence of inadequacy. Caregivers and rescue workers, in turn, may respond with irritation or withdrawal from the survivors, despite the fact that they survivors are not to blame for their distress.

The reactions described above are painful to experience and painful to observe in others. But there is another side to the responses of survivors. Most survivors act appropriately, to protect themselves and their loved ones. In most disasters, despite mythology to the contrary, survivors show little panic. Many engage in heroic or altruistic acts. Many are able to help others, even at considerable risk or cost to themselves. The same person may appear simultaneously as a victim in need of help and as a problem solver, trying to cope with their family and neighbors.

Depression and Grief

• Sadness, hopelessness, crying, despair, apathy, inability to stop grieving.
• Difficulty sleeping, moving slowly, chronic fatigue, loss of appetite.
• Guilt; seeing self as no good; shame.
• Feelings of helplessness, ineffectiveness.
• Social withdrawal.
• Suicidal thoughts or attempts.
• Irritability, hostility, sudden anger.
• Moodiness, sudden shifts in emotional state.
• High risk behaviors-sexual promiscuity, reckless driving, use of drugs or alcohol.

Dissociate Experience

• Emotional “numbness,” lack of feelings, callousness, emotional flatness.
• Thinking about terrible events without any feelings; awful feeling without knowing why.
• Feeling as if in a dream; feeling unreal; feeling world is unreal.

Somatic Disorders

• Poorly defined aches and pains in head, back, limbs, neck; urinary frequency; palpitations; gastrointestinal trouble; hair loss, change in menstrual cycle; changes in hearing or vision.
• Loss of sexual desire or difficulties in sexual performance.
• Sleep difficulties.
• Sinking feelings, feeling of cold or heat in body; heaviness of heart; heat in the chest.
• Muscular tension; twitches, tics, tremors.
• Dry mouth, clammy hands.

Spiritual Discontents

• Loss of faith in God.
• Belief one has been cursed by God.
• Cynicism.
• Lack of sense of meaning.

Anxiety

• Worry, excessive fears, panicky feelings.
• Hyper vigilance, suspiciousness, always on guard.
• Irritable, restless.
• “Hyper arousal”: Muscular tremors, tics, tensions, dry mouth, clammy hands, exaggerated startle reflex.
• Avoidance of places, sounds sights, smells associated with traumatic events.

Re-experiencing

• Flashbacks, intrusive memories and thoughts.
• Nightmares.

Cognitive Symptoms

• Difficulty concentrating, difficulty making decision.
• Memory difficulties, amnesia for the traumatic event.
• Confusion, disorientation.
• Slowed thinking.
• Brief psychotic experiences hallucinations, (delusions).

Interpersonal Difficulties

• Inability to trust others or feel safe with others.
• Suspiciousness, hyper vigilance.
• Lack of empathy; loss of respect for others.
• Increased marital conflict or conflict with children or conflict with co-workers or with others in community.
• Exaggerated need to control others.
• Exaggerated dependency, clinginess.

Miscellaneous

• Trance states.
• Sense of desperation.
• School or work difficulties.
• Lack of motivation.
• Seizures.
• Post-traumatic Symptoms.

Coping with the Trauma

1. Identify the feelings that you may be experiencing. Understand that your feeling are a normal reaction to an abnormal situation.
2. Remember that you have overcome adversity and trauma in the past. Try to remember what you did that helped you overcome the fear and helplessness in that situation.
3. Talk to others about your fears. It’s okay to ask for help. Convene small groups with a counselor so people can share feelings
4. Make efforts to maintain your usual routine.
5. Think positively. Realize that things will get better. Be realistic about the time it takes to feel better.
6. Recognize that the nature of trauma creates fear and uncertainty about the future. Continue to do the things in your life that you enjoy. Don't get preoccupied with the things you cannot control to the extent that they prevent you from living your normal life.
7. In the case of terrorism, know the actions our government is taking to combat terrorism and restore safety and security. Recognize that trained officials throughout the country are mobilized to prevent, prepare for and respond to terrorist attacks.
8. Limit exposure to media coverage.

COUNSELING AND WELLNESS CENTER

If a student is unwilling to seek counseling regarding trauma and is NOT in a lifethreatening situation, contact the Counseling and Wellness Center at 607-871-2300, for further assistance. If the suicide situation is life threatening, contact the Alfred Village Police, 607-587-8877, or Alfred Village Emergency, 911.

WEB SITES

For additional information on this, and other Trauma Topics, contact:

http://www.apa.org/topics/topic_trauma.html
www.trauma-pages.com
http://ub-counseling.buffalo.edu/vpc.html