In this section we will attempt to answer some common questions regarding trauma, and to explain different cases of psychological trauma, their causes, their consequences and the way they are treated. The answers were provided by the head of our clinic, the clinical psychologist Mr. Joel Wardi.
Trauma is the experience of threat and dread which overwhelms an individuals normal coping ability and leaves them helpless. These events are usually unpredictable and cause a paralyzing fear and a feeling of helplessness. Some cases of trauma are caused by external circumstances such as earthquakes, drowning and other natural disasters, and others are caused by damage done by other people – intentional or unintentional and negligent. A third group of trauma are injuries caused within a trusting relationship, such as sexual abuse of children, sexual abuse within the family, violence in a romantic relationship, abuse of authority (abuse within a relationship with an authority figure – a psychologist, a doctor, a teacher…)
The traumatic experience might be a situation in which there was a threat to a persons life or a threat of physical injury, or a threat to a loved one – such as assault, war, accidents and physical pain. The overwhelming experience of threat might also result from the breaking of a persons deepest beliefs regarding himself – for example, a mother who can’t protect her children, or a soldier who injures a child or a friend while on duty. In addition, sometimes the traumatic experience results from a difficult event that happened to the person such as receiving grave news of betrayal or loss.
Post traumatic disorder is defined by the reaction to the event. It is impossible to diagnose post trauma strictly by the nature of the event, as difficult as it may have been, without observing and understanding the persons reaction and experience of it. The meaning of the word ‘Trauma’ in Greek is ‘wound’, and using this metaphor – we can say that it involves a wound that does not heal on its own.
The post – traumatic injury is experienced as a very physical experience, and includes disturbances in physical processes that usually occur smoothly and automatically: dysregulation in breathing, digestion, sexual function, and feelings of body temperature. Moreover, the dysregulation is also seen in arousal levels: there are sharp transitions between states of emotional flooding and experiences of distance and disengagement. When a person is in a state of emotional flooding he might feel like the injury is happening right now, and on the other hand when he is in a state of disengagement it might feel like the event happened to someone else, or in a movie.
These sharp transitions are also seen in behavior and relationships: a person might be highly sensitive, there are emotional outbursts which alternate with behaviors of withdrawal and disengagement from the environment.
The time perception also changes: the trauma survivor might feel like the past and the present mix together without being able to keep a stable feeling of continuity in time. Sometimes the dangerous past feels more real than the calm present. In addition, the alteration in the experience of time creates a feeling of incompatibility – like the person is living in a different reality than the rest of the world.
There are several areas in which we see typical reactions:
Avoidance: The injured person avoids places, objects, situations and people who remind him of the event. In addition, as another mean for avoidance he might narrow and reduce his inner world – avoid certain thoughts or avoid talking about feelings that relate to the trauma.
Over arousal: The person is in a constant state of alertness, and feels like he has to be ‘on guard’ and prepared for action at any moment. This state negatively affects relationships, sleep patterns and the ability to concentrate.
Invasiveness: memories and ‘memory pieces’ related to the traumatic event invade the consciousness and take over the entire experience at a given moment. This phenomenon might occur in nightmares, flashbacks, reaction to images, sounds, smells or words that remind the person of the event.
Negative perceptions: The injured person sees himself, others and the world in general in a negative light. For example: he might think himself weak, defective or a failure. Others might seem aggressive or ashamed of him, and the world might be perceived as arbitrary, estranged or persecuting.
There are typical signs that indicate a need for treatment after a traumatic event:
* Difficult feelings and disturbing memories of the event
* a lack of improvement and a difficulty to return to regular functioning weeks and months after the traumatic event.
* An avoidance of any mention of the event, as a way to protect oneself.
* Difficulty sleeping
* Extreme emotional reaction when the event is mentioned.
* Inability to enjoy things the person used to enjoy
* A feeling that the everyday interaction with the world has become hard or intolerable.
* Changes in behavior: anger, apathy, mood swings, depressed mood, withdrawal, disengagement.
* Rage or crying outbursts
* Anxiety
It’s important to remember that in most cases after difficult and overwhelming experiences we recover naturally. The human ability to get up and recover after taking a hit is remarkably good. The advisable thing after a traumatic experience is to take some time for healing and to get support from the close environment and community.
The post traumatic disorder is a disorder of non – recovery. In other words, all of the immediate responses to the traumatic event are normal: confusion, inability to sleep, anger, obsessive thinking about the event, disengagement, unexplained physical pain – all of those are natural in the first few days after the event. It is recommended to ask for an evaluation from a professional if there is no improvement 3-4 weeks after the event.
In the treatment of trauma the patient tries to process what happened and to internalize the fact that it happened. The patient must process the fact that the traumatic event happened in a frightening and uncontrollable way, and that now we are actively facing the memories and consequences of the event. Paradoxically, only when a person is able to really accept that the event happened can he accept that it is now over. There are many different treatment methods, which have one thing in common: they all aspire to create some order out of the chaos – to find and create continuity and meaning in the events and find a safe place for them in the persons life story and personal identity.
Trauma creates survival reactions – the person injured by the trauma responds instinctively to himself and his everyday reality with paralysis, emotional flooding or avoidance. These reactions appear as post traumatic symptoms. In treatment we work on expanding the ability to meet and contain the traumatic history and the reactions to it, so the person could reclaim them and finally integrate them in his life story. In this journey, he approaches the main negative feeling in the traumatic history – shame, failure, dread, helplessness and guilt – and gradually changes them to broader and deeper meanings that might be used as a base for hope and personal growth out of the darkness.
Givat Shaul, Herzog Medical Center, Jerusalem.
P.O.B 3900, Zipcode 91035
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