Dealing With Trauma and the Healing of Memories

From Peacebuilding

Author: Bob Schreiter

Contents 1 Introduction: What is trauma? 2 Other factors in the study of trauma 2.1 The history of studying trauma 2.2 The epidemiology of PTSD 3 Social trauma 3.1 The trajectory of social trauma: Repressing social trauma 3.2 Dealing with social trauma 4 Overcoming individual trauma 5 Secondary trauma 6 Spiritual resources for dealing with trauma

Introduction: What is trauma?

One of the common occurrences in situations of conflict is the experience of trauma. In World War I, only ten percent of those affected by war were civilians. That number increased to fifty percent in World War II, and to over ninety percent in the war in Kosovo. Aid workers are likely to encounter cases of trauma in post-conflict situations.

Trauma is defined here as the feelings aroused from witnessing or experiencing events that bring about actual or threatened death or serious injury or threat to physical and bodily integrity, either to oneself or to others.

Trauma is an extreme stress reaction. It can occur when one sees others being injured or killed, when one witnesses the destruction of one’s home or that of a neighbour, when one has to flee familiar surroundings out of fear for one’s life, or experiences or witnesses rape and other bodily abuse.

Judith Herman’s description of the dynamics of trauma sets out well the experience:

Traumatic reactions occur when action is of no avail. When neither resistance nor escape is possible, the human system of self-defence becomes overwhelmed and disorganised. Each component of the ordinary response to danger, having lost its utility, tends to persist in an altered and exaggerated state long after the actual danger is over. Traumatic events produce profound and lasting changes in physiological arousal, emotion, cognition and memory. Moreover, traumatic events may sever these normally integrated functions from one another. The traumatised person may experience intense emotion but without clear memory of the event, or may remember everything in detail but without emotion. She may find herself in a constant state of vigilance and irritability without knowing why. Traumatic symptoms have a tendency to become disconnected from their source and to take on a life of their own.

[Judith Herman, Trauma and Recovery: The Aftermath of Violence – from Domestic Abuse to Political Terror (New York: Basic Books, 1997 [revised edition]), p. 34]

The traumatic reaction is an oscillation between what psychologists call hyperarousal and dissociation. Hyperarousal is part of the body’s alert system that is engaged in situations of danger. he traumatic event creates fear and vigilance against further assault. Typical symptoms are:

• Intrusive recollections or flashbacks of the event which the person cannot control or banish from consciousness

• Feeling like the traumatic event will occur again

• Distressing dreams about the event

• Inability to fall asleep or stay asleep at night

• Heightened irritability and outbursts of anger

• Difficulty concentrating and continuing to be hypervigilant

• Intense psychological stress at any exposure to cues that trigger remembrance of the event.

Dissociation is a fragmenting of consciousness and a numbing of normal feelings. Symptoms include:

• Avoiding thinking or talking about the trauma

• Avoiding people and places associated with the trauma

• Feelings of disengagement or estrangement

• Restricted sense of feeling or affect

• Inability to remember important aspects of the trauma

• Sense of having little or no future (i.e., that one will not have a normal life span).

Trauma victims find themselves swinging between these two sets of symptoms. Indications of this state include chronic fatigue, psychosomatic illness, emotional outbursts and withdrawal, fits of weeping, and alcohol or drug abuse.

The result of suffering from trauma includes a sense of meaninglessness and hopelessness, loss of faith in the trustworthiness and benign character of the world, and helplessness in responding to it.

Other factors in the study of trauma

There are some additional elements that are useful in the study of trauma: the history of this study, and how attitudes have changed; who may suffer trauma and how.

The history of studying trauma

In the nineteenth century, trauma was first diagnosed in women, and was called hysteria, since it was felt to be caused by the womb. In retrospect, the symptoms may have been caused by physical or sexual abuse. Sigmund Freud was an early student of this kind of trauma, and psychoanalysis continues to be a major approach to treating trauma.

The stress reactions to the fighting and carnage of World War I brought interest in trauma in men. It was originally called shell shock or combat fatigue. Such reactions were seen as a sign of moral or character weakness (since other comrades did not seem so affected).

Research after World War II and the war in Vietnam led to the conclusion that every person has a breaking point when too much stress is experienced. Studies of Holocaust survivors have greatly increased our knowledge about traumatic stress. In 1980 the American Psychiatric Association gave this diagnosis the name Post-Traumatic Stress Disorder (PTSD). This is the common designation used today.

Starting in the 1990s, more research was being directed toward the physiology of PTSD. It has focused on the sympathetic nervous system’s reaction to stress, and the role of the amygdala and the hippocampus in the mid-brain (the region where emotions are processed). The size of these two organs may be important: i.e., those with smaller organs may not be able to process enough corticol (a stress-reducing hormone generated in the pituitary gland) to relieve the stress reaction. Work is still continuing on this area.

The epidemiology of PTSD

Researchers now agree that anyone may experience PTSD if the trauma experienced is severe enough. There is no strong correlation between general psychological well-being and capacity to resist PTSD, although such general well-being may be a factor.

Most PTSD symptoms disappear within one to six months for most people. However, if one is exposed to multiple or ongoing traumatic events (such as incarceration), the symptoms will continue. This is especially true in situations of persistent physical or sexual abuse. If PTSD is still in evidence after six months, it should be addressed. Untreated PTSD can lead to serious illness or premature death.

Western psychology has developed techniques, in both psychoanalysis and other forms of psychology, to treat these symptoms. These techniques are generally not available nor well understood outside the West – precisely where much of the trauma is being experienced. For that reason, traditional forms of healing and ritual understood by those who are traumatised have proven helpful in many instances. Story-telling (i.e., recounting the story of the event over and over until it loses its emotional hold on the individual) is also very useful.

Generally speaking, there are not major gender differences in responding to PTSD. Specific cultural features may enhance or impede recovery. Men having strong “macho” images may not want to acknowledge their feelings of fear and helplessness. Women whose cultures have taught them to be submissive may not have (initially) the ego strength to overcome the experiences. At the same time, women’s experiences of having learned how to endure adversity may be in their favor in overcoming PTSD.

PTSD symptoms among children may manifest themselves in hyperactivity and obsessive re-enacting of elements of the trauma. Children tend to fragment the experience more than adults, so that they may focus on certain elements and avoid others. They are at once attracted to the trauma and repelled by it. Because of still developing linguistic and conceptual capacities, children often lack the means to put into words their feelings and experiences. Acting out their feelings provides an important access to trauma in their lives.

Social trauma

Conflicts typically create widespread or social trauma. Whole populations will appear to be traumatised. Where the rape of women has been used as a military strategy, large numbers of women will experience not only PTSD as described above, but deep cultural shame that makes it difficult or impossible for them to reintegrate into their families. When people have seen their homes destroyed or have had to flee elsewhere for safety, the trauma can remain an open wound. Having to return to a burned-out area that was once home reopens the experience of trauma. Similarly, anniversaries of the traumatic event bring the traumatic experience back to the surface. New experiences of trauma can reopen old experiences of trauma as well.

[The leading student of social trauma has been Vamik Volkan. See for example his Bloodlines: From Ethnic Pride to Ethnic Terrorism (Boulder, CO: Westview, 1997). See also Jeffrey Alexander, Ron Eyerman, Bernhard Diesen, Neil Smelser and Piiotr Sztompka (eds.), Cultural Trauma and Collective Identity (Berkeley: University of California, 2004).]

The trajectory of social trauma: Repressing social trauma

When the fighting has stopped and people can return to their homes, a variety of responses are possible. It is not uncommon for groups to try to suppress memory of the trauma, and try to get back to living a “normal” life. They often do this so as not to burden their children with the memories. However, memory of the events is likely to return in the social sphere at some point. Because of its having been repressed, its breaking out will be less controllable than it might have been. The emotion may also have become attached to another object or event (what psychologists call “displacement”). This makes it even more difficult to handle. It may resurface as well at times of stress in the post-conflict society, such as a new external threat or a defeat. Repressed social trauma is a major source fuelling conflict in post-conflict societies or among refugee communities. Because the source is not acknowledged, it is harder to deal with.

Although victims will try to repress trauma so as to protect their children, at a certain point children (especially when they come of age) will start asking questions about what happened. This can create intergenerational conflict. This contributed to social conflict in German society in the 1960s when teenagers started asking their parents questions about what they did in the war.

Trauma can be transmitted to the next generation consciously or unconsciously. When it is consciously transmitted consciously, it is called “chosen trauma.” Chosen trauma is a conscious effort to transmit the resentment about powerlessness to the next generation. Often out of loyalty to their parents, children will often gladly accept the burden of chosen trauma. Such transmitted, chosen trauma can harden into the identity of a people. Slobodan Milosevic used the memory of the defeat and humiliation of Serbs by the Ottoman Turks in 1389 to ignite the Balkan conflict six hundred years later.

Such transmitted trauma usually takes the form of unconditional hatred of the outgroup. People in the outgroup are no longer seen as human beings. This legitimates doing whatever is necessary to exterminate them.

Likewise, such transmitted trauma can legitimate a culture of victimhood, where the next generation is taught that there is nothing they can do about being victims. This can legitimate all kinds of behaviour that otherwise would be considered unethical (such as suicide bombings, refusing to enter any negotiations, and the like).

Trauma can be transmitted unconsciously as well. This one sees in situations of domestic violence wherein the violent behaviour of a parent surfaces in the violent behavior in domestic situations of the children once they are adults. [On the transmission of trauma, see Vamik Volkan, Gabriele Ast, and William Greer (eds.), The Third Reich of the Unconscious: Transgenerational Transmission and Its Consequences (New York and London: Brunner-Rutledge, 2002).]

When trauma victims reach old age, they often want to speak of the social trauma they experienced. While having refused to speak of it at an earlier age, they now want subsequent generations to remember what happened to them. They will lobby for monuments to be set up as memorials to their suffering. The sixtieth anniversary of an event is usually the most important, since thereafter few if any survivors of the trauma will still be alive to share memories. Events commemorating the end of the Second World War at the sixtieth anniversary (2004-2005) were symptomatic of this.

Dealing with social trauma

Usually social trauma cannot be addressed in the immediate aftermath of conflict beyond attempts to create safety (see below for more about this). But shortly thereafter it is wise to encourage addressing the trauma. Societies are not able to undo the past – recreate the society which one existed or bring back the dead – but they can do certain things. Trying to set the record straight about what really happened, and making sure that those events are not forgotten are important aspects of this. Truth Commissions have become an important way of doing this. They can serve to lift the silence about what really happened, counter the lies that were used to legitimate the conflict, and exonerate those who were falsely accused or punished in the conflict. Forms of compensation to survivors are another step that can be taken, although many societies are so impoverished after conflict that this is not possible or realistic.

At an appropriate time (no later than the end of the lifespan of those who suffered most), monuments are sometimes erected to commemorate those who suffered and died. This kind of symbolic action serves several purposes. It keeps in memory those who perished and those who struggled to overcome. It is a symbolic way of bringing back the dead among the living. Other ritual practices – such as reburying the remains of those put in mass graves – can help bring closure to the experience.

Taking preventative measures to insure that the conflict does not reoccur is another important step. This may involve the rewriting of school textbooks recounting history. It may involve realigning social structures that promoted poverty or discrimination that had fuelled the conflict.

Overcoming individual trauma

The outcome of trauma is a sense of confusion, loss, and helplessness. Put most simply, it is a profound breach of the basic trust necessary for people to relate to one another in society. Overcoming trauma involves countering these feelings.

If the symptoms of individual trauma are feelings of helplessness and isolation, the road to recovery must involve building a sense of empowerment and reconnection.

Since basic trust is at stake, the first thing to do is to try to create safety. It is important that victims recover a sense of being safe, of not being harmed another time. Such gestures as restoring some sense of routine to daily life are important here. Securing boundaries to keep out harm has to be done in physical as well as symbolic ways.

Issues of health loom large here as well. Restoration of bodily integrity as much as possible is a prelude to dealing with the psychological issues to be addressed. The confusion and fragmentation of traumatic experience are best addressed by gathering people in safe places and allowing them to tell their stories. Stories are a means to reconnect dissociated experiences and feelings. The purpose of telling and re-telling the stories is to develop gradually a different perspective on the events, a perspective that does not keep the victim a prisoner of the toxic experience. It also allows victims to explore questions of meaning and of guilt. Such questions are:

• Why did I survive when so many others perished (survivor guilt)?

• Why did God permit this to happen (meaning and faith)?

• Could I have done something to avoid this situation or protect my loved ones better (causality and meaning)?

• How can I live after all this (hope)?

Loss is addressed by mourning. The explicit naming of who and what have been lost, and the explicit leave-taking of those people and those things which are gone forever is often best done in ritual ways consonant with the culture of the survivors.

If victims have been maimed in the violence, coming to terms with their disability adds another layer of recovery work to this. They must learn to claim their own disability, distinguish between their persons and their disabilities, and find meaningful relationships within their families that will help them feel accepted despite their losses.

Mourning loved ones is especially difficult when one does not know their fate or where their bodies are to be found. Many cultures have a strong sense of performing certain rituals if the dead are to pass safely from this life to the next. Finding modified ways of doing this is important if the survivors are to find peace.

Whole belief systems may need to be reconstructed. In closed systems – where every event must have a cause – care must be taken not to stigmatise certain individuals or groups as the source of the trauma. Witchcraft accusations are often used in these situations, and people are punished or killed. Belief in God may also be put to the test. At the appropriate moment the shattering of worldviews can be seen as an opportunity to create a new, more comprehensive worldview so that people can live with a sense of safety, meaning, and hope in a changed world.

New relationships will need to be formed in order to overcome the feelings of isolation and being disconnected. The nature of these new relationships must be such that they empower victims to feel they are retaking charge of their own lives and the lives of their families. Part of the message of empowerment is that victims are worthwhile human beings; they are lovable, despite the terrible things that have happened to them. Any accompaniment of the victims by aid workers or therapists that create new dependencies in the victims will impede the healing going on.

Finally, victims must come to realise they cannot return to their lives as they were before. They will need to find a new way of being, since the trauma has changed them forever. Finding constructive new pathways is important for recovery. They must be aware too that even though they may have experienced healing, anniversaries and events may set off the experience of trauma again. There are likely to be pools of emotion that the healing process has been unable to touch. Having such an experience of trauma resurfacing does not mean that the healing that has taken place is undone or wrongly done. Trauma can simply be so deep-reaching that victims – although they may have become survivors – will still have to live with the prospect of new events triggering these old feelings. They need to be reassured when this happens that they are not coming apart as human beings.

Secondary trauma

Persons working with victims of trauma may find themselves exhibiting the same symptoms as those whom they are trying to help. This kind of taking on the same feelings as those of the victims is known as secondary trauma (in psychoanalytic circles, it is known as counter-transference). This is not unusual among aid workers, since helping others is a strong motivational force for them.

Secondary trauma sufferers exhibit symptoms of hyperarousal and dissociation, such as irritability, chronic fatigue, and difficulties in sleeping. They may redouble their work efforts to expunge these feelings, and not get necessary rest. They may abuse drugs or alcohol in order to “relax.”

If workers have unresolved trauma in their own past, they may be attracted in a special way to trauma situations. Working in trauma situations may be a way of proving to themselves unconsciously that they are OK, strong enough to overcome the debilitating effects of trauma. They may actually seek out trauma. In the worst case scenario, they may endanger themselves and others by taking undue risks. When this happens co-workers should make every effort to remove them from the trauma situation as quickly as possible.

The best antidote to secondary trauma is a commitment among workers to monitor one another, and speak honestly when they detect obsessive behaviour. Regular debriefings of workers in groups help manage the stress as well.

Spiritual resources for dealing with trauma

A person’s religious beliefs may be a major source for dealing with the effects of trauma [For a practical guide from a Christian point of view, see Margaret Hill, Harriet Hill, Richard Bagge, and Pat Miersma, Healing the Wounds of Trauma: How the Church Can Help (Nairobi: Paulines Publications, 2004)]. At the same time, fundamental beliefs may be challenged by the horror of the situation and the chaos of the aftermath.

Christian belief in God is grounded in the idea that God is a God of love. Creation has come about through God’s loving action. As a result Christians believe that creation is good and intended to be meaningful.

At the same time, Christians believe that evil and sin have entered that world. How this happened or why it happened remains shrouded in mystery, but evil and sin are very real experiences in the world.

The story of Jesus, especially regarding the meaning of his suffering and death, is intended to counter that narrative of evil and sin in our world. Jesus suffered torture and death even though He was innocent. That suffering and death, which God has reversed in the resurrection of Jesus, puts a clear boundary on the suffering we experience in the world. God comprehends it, even if we cannot. God has encircled it in the death of Jesus. Even though it may seem boundless to us, God does not see it that way. That is what gives us hope that we will, with God’s help overcome the suffering we are now experiencing.

For some, what they have suffered negates this story altogether. In any event, overcoming trauma means a new relation to self, to others, and to the world. That will include a different relationship with God. For some, the shattering of the image of a paternal God who protects us from all evil means that God cannot exist at all. For others, it is a realisation that our images of God only approximate for us who God is, and the shattering of one image is an invitation to a new, more comprehensive image. To live in trauma, however, is to live between the old image and the new one. Trying to remain faithful in that time can be an experience of finding once again that basic trust without which there is no human life.