Here are four scenarios for you to ponder:
1) “OMG, my boyfriend just sent me a text message that he was breaking up with me. Can you believe that? I’m going to kill myself. That’s all I can do. I’m just going to kill myself. My life is over, do you hear me? OVER!”
2) “Dispatch, this is Unit 1. We’re on the scene and have found a young male, aged seventeen. Victim was ejected from the vehicle, which appears to have traveling at a high rate of speed and did not make the curve. Strong smell of alcohol on board, with bottles in the floorboard of the vehicle . Victim is non-responsive and has massive head injuries. Victim was not wearing seat belt at the time of the accident.”
3) “We are pinned down behind the ridge. I repeat, we are pinned down behind the ridge. We are being flanked. We cannot hold. I say again, we cannot hold. We need immediate air support. We will…” (silence)
4) “This is 911. What is your emergency?” “I’m calling from the attic of my house. The water is rising, oh, Lord, it’s rising so fast, it’s rising so fast. Please, please, please….send help. We’re trapped here. Please send help. We’re as high as we can go. Please help us.”
These four scenarios, all very different from one another, are examples of emotionally traumatic situations. A text message to a young jilted teen may be the worst stress she has ever endured and make her feel that her life is over. Coming upon an accident scene where a young man has been fatally injured and could have been saved by wearing a seat belt can be devastating to even the most well-trained EMT. Serving in the armed forces and being in the middle of a hot zone with a very real chance of losing your life, or knowing that some of your buddies will lose theirs, is the classic picture that many of us see in our mind’s eye when we hear the term “post-traumatic stress disorder”, or PTSD. The last scenario, a frantic call for help on a dying cell phone from a hot New Orleans (or Houston or Miami) attic, is one that most of us, thankfully, have never had to face. Many of our countrymen have.
I have learned over the years through my work in hospitals, mental health centers and emergency rooms that emotional trauma is a very intimate, individual experience. What might be a minor inconvenience to me might seem insurmountable to you. The loss of a spouse after forty years of marriage might seem the end of life for a man who loved his wife dearly, but it could be a blessed relief to a woman whose forty year marriage has been a hell of abuse, alcohol, and lies.
Some things are clear.
Trauma usually involves an experience or an event or a situation that you would not expect to find yourself in. You may fear for your life, or you may witness the severe injury or death of another. You may be subject to unspeakable abuse. You may lose everything. It hits you out of the blue, sucks the air from you, stops your breathing, sucker punches you. Many things that we think of as traumatic are sudden, intense, and very hard for us to deal with. We deny that they are happening (being stuck in the middle of one of the worst hurricanes the Gulf Coast has ever experienced, for example), we tell ourselves that they are reversible (the sudden death of a spouse), or we try to get a second opinion that will countermand what we already know in our gut to be the truth (a newly delivered diagnosis of metastatic and terminal cancer).
Other traumas are insidious, long-standing and injurious over time. Think of the little girl who is sexually abused by her step-father at age seven, who endures this indignity over years, marries at age sixteen and leaves home to escape the trauma, only to find herself repeating the cycle over and over again in abusive relationships as an adult. Think of the mixed race child who has one foot in each of two (or more) worlds, not really knowing who he is or where he fits in, shunned by one race and ridiculed by another. The very color of his skin and his ethnic background makes living his life a daily trauma, much of which is not even under his control. The worst kind of stress is that over which we have absolutely no power.
Responses to trauma can range from acute stress reactions (shortness of breath, rapid heart rate, feeling faint, getting physically sick) to chronic means of coping (alcoholism, acting out, ongoing depression, inability to hold a job). One can pass from one way of dealing with trauma to another and back again. Avoiding dealing with the stress or the event or the abuse or whatever the initial trauma was can be devastating over time. Reliving the trauma, being exposed to triggers or having flashbacks can sometimes reinjure a vulnerable person hanging on by a thread.
Acute stress disorder may be seen in as many as six per cent of survivors of industrial accidents, twenty five per cent of victims of robbery and assault and thirty three per cent of mass shooting survivors. As a matter of fact, a history of previous mental health treatment, previous PTSD, or depression may make a person more vulnerable to acute stress when confronted with a scenario like those mentioned above. Acute stress disorder is only seen and diagnosed in the first month after a traumatic event, but if symptoms last longer, then PTSD should be considered.
When faced with trauma such as the political, social and meteorological events of the last few years, what may we do to support each other and help, not hurt, the traumatized?
Encourage those experiencing stress, whether acute or chronic, to seek help. As you well know, first responders, the Red Cross, Salvation Army and countless other groups have been on the ground during so many of these incidents to make sure that those who suffer are given necessities such as food, water, clothing, pillows, blankets and medicine, vital for those first few hours to days after an abrupt traumatic even such as a hurricane or flood. No other treatments will be successful if someone is worried about shelter, food, water or their personal safety.
When personal safety is no longer an issue, cognitive behavioral therapy, along with medications or other interventions as needed, can be very helpful not only in decreasing acute symptoms but decreasing the chances of developing post traumatic stress disorder later on. Debriefing of first responders and disaster victims, something that used to be a standard procedure in the field in real time, may sometimes exacerbate trauma.
As is often the case in life, sometimes when we are under the most extreme stress, the best thing we can do is reflect on what has pulled us through before and make every effort to use those same coping skills to survive, bolstered by the efforts of those who come to our aid in times of great need.