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October 8, 2013

What is trauma?

Reuel S. Amdur

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On September 18, there was a horrific accident in Ottawa, involving a bus and a train, with injury and loss of life. In quick response to this event, the Royal Ottawa Hospital held a public information session a week later, to inform survivors, families and friends, and the general public about how to cope with such traumatic events. Psychologists Luis Oliver and Michele Boivin presented the information.

Boivin began with what traumatic loss is.  It is exposure to actual or threatened death, serious injury, or sexual violation.  Exposure may be directly experienced or it can be witnessed or simply through learning of the event.

A person suffering trauma may have a variety of psychological responses: unwanted thoughts, nightmares, poor concentration, fear or anxiety, anger, irritation, guilt or blame, grief, sadness.  The consequent behaviors might include effort to avoid things that remind the person of the event, withdrawal, substance abuse (drugs, alcohol), hyper-vigilance, a feeling of numbness.  Symptoms might include insomnia, change in appetite, nausea, fatigue, tension, headache.

It is normal for those experiencing trauma to have such transient symptoms, which should begin to decline within several weeks, certainly within a year.  Recovering from trauma is associated with re-establishment of previous activities.  This can involve getting support from natural supporting networks such as family, friends, or religious community.

Some things can get in the way of natural recovery: ongoing avoidance, being extra-careful, efforts to avoid thoughts and memories of the event, efforts to distract oneself by being too busy, constant ruminating over the event, hypervigilance, substance abuse, and giving up activities that were previously enjoyed.  These things may be experienced in the immediate aftermath, but persistence will be a problem.

Oliver said that a traumatic loss is one that is sudden, unexpected, or violent, caused by another person, accident, suicide, natural disaster, or other catastrophe.  Reactions may include shock, difficulty in accepting what happened, and prolonged memory or dreams.  Fear and anxiety may be manifested in feeling unsafe in normal activities.  Anger may involve feeling of being helpless and out of control.  Guilt might manifest itself around regret about what the sufferer has or has not done.  The person may also feel guilt about surviving and guilt about going on with life.

There is no one right way to grieve.  We are all different, as are our patterns of grieving.  Among ways of grieving, one may connect with a support system.  Collective grieving may be useful in many cases—a vigil, spiritual services, or a sharing of recollections.  In individual grieving, a person might follow old traditional patterns or establish new ones, find ways to remember, and allow a range of emotions.  It is important for the person to continue to take care of himself and eventually to re-engage in normal activities. 

Because there is no one right way, members of the same family may grieve differently, and family members need to accept that.  There may be a desire to create a legacy for the fallen, and a person may want to re-evaluate what of that life which was lost is important.

First responders need to be able to provide psychological first aid, including a safety plan and emergency support.  Survivors need support, an individual meeting, a review of the details of the event, and the opportunity to discuss the experience.  They also need information about trauma itself.

There are certain do’s and don’ts in helping sufferers.  Do listen, be constantly available, accept the person’s initial coping pattern, encourage natural supporting networks, and limit but not eliminate exposure to media reports.  Don’t: minimize, take control over the person’s well-being, give advice, judge, pathologize normal reaction, or personalize reactions.  Do not jump to the conclusion that mental health intervention is needed.

But there are exceptions, where help is needed right away—if the person threatens to harm himself or others, if substance abuse is excessive, if the person engages in dangerous or risky behavior, or if the person is unable to care for himself or others for whom he is responsible.

Trauma does not usually lead to post-traumatic stress disorder (PTSD). 

Half of all women and 60% of men experience trauma at some time during their life.  Of these, eight per cent of men and 20% of the women progress to PTSD.  Risk factors for PTSD can be identified before, during, and after the traumatic event.  Prior, factors include a family history of mental illness, previous trauma, or previous maladjustment.  Factors at the time of the event include perceived threat to life, intensity of emotions, and dissociation.  After, the predictors include lack of social support, serious life stresses, and severe symptoms.

PTSD exists when the person starts to organize his life around the trauma and when the trauma lasts for more than a month.  It may involve impairment of relationships, activities, work, self-care, or basic responsibilities, for example, getting the children off to school. 

In the event of PTSD, one should look to one or more of the following for help: the person’s natural supports, the family doctor, the employer’s employment assistance program, and social agencies such as family agencies, mental health professionals such as psychiatrists, psychologists, social workers, and pastoral counselors.

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