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November 6, 2016

Coping with Trauma and Loss

Reuel S. Amdur

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Most people experience at least one traumatic experience in their lifetime. That is what psychologist Katie Bendell recently told an audience at a lecture held at the Royal Ottawa Hospital. She and her colleague Keegan Barker spoke about trauma and loss.

Bendell described trauma as an event or situation that overwhelms the ordinary human adaptation to life.  It can involve exposure to actual or threatened death, serious injury (an accident, assault, or torture), or sexual violence.

A traumatic experience may be something that happened to the person directly.  Alternatively, one may have witnessed such an event or learned that it happened to someone close.  Trauma can also be experienced by repetitive or extreme exposure to details of such an event or situation.

Common reactions to trauma include unwanted thoughts, nightmares, and poor concentration and loss of short-term memory.

Emotional reactions may be varied—fear, anxiety, anger, irritableness, guilt, shame, grief, sadness.  A person may have disturbed sleep, change in appetite, fatigue, tension, and headaches.  Changes in behavior may include effortful avoidance, withdrawal, substance abuse, hyper-vigilance. 

She spoke of natural recovery from trauma. 

Transient symptoms are normal while the brain processes the experience or situation.  In such case, the trauma diminishes within several weeks of the incident, certainly within the year.  Recovery is established when the person is able to re-establish pre-trauma activities.

On the other hand, if the person is stuck and unable to move beyond the trauma, there is a pattern of avoidance: hyper-vigilance and being extra-cautious, pushing away thoughts and memories, staying busy and distracted, ruminating, substance abuse, giving up enjoyable activities. 

If the trauma persists, there are possible negative consequences: PTSD (post-traumatic stress disorder), depression, anxiety, substance abuse and possible dependence, eating disorders, and psychosis.

Bendell then turned to loss. 

Grief is a common reaction to loss.  There may be psychological, behavioral, social, and physical reactions.  Many of the things said about trauma apply as well to grief.

There may be feelings of uncertainty and lapses of memory.  Also, sadness, fear, anxiety, anger, irritability, regret, helplessness, sadness, sleep disturbance, tension, lack of motivation, isolation, avoiding others, and reduced intimacy.  She singled out sadness as promoting the healing process. 

People experiencing loss and grieving tend to raise the existential questions: Who am I?  Why are we here? Is life worth living?

In the process of mourning, we need to recognize the loss, react to the separation, recollect and re-experience the relationship while at the same time relinquish the old attachment.  The process involves readjustment and moving adaptively to the new without forgetting the old.  There is a reinvesting in what is important to the person.

If the person is stuck in grief, there is an impact on functioning and quality of life.  Yet, part of moving on is the need to experience pain, she asserted. 

Keegan Barker took up after Bendell to tie trauma and loss together. 

Each may lead to the other.  In each condition the person loses sense of self and trust in others.  Is the world a safe place or not?  Trauma and/or loss may affect relationships and job performance.  It may be difficult to accept the reality of a loss.  Insomnia or bad dreams may occur. 

What, she asked, can we do in the face of trauma or loss? 

We need to be resilient and accept challenges and we need to adapt.  Hope is a key.  Barker quoted Bishop Desmond Tutu, who said that hope is being able to see that there is light in spite of the darkness.

One task for the sufferer is to reframe thoughts.  “I’m a mess and no good” needs to be translated: “I’m having a hard time.”  There is a need for self-compassion, self-knowledge, and honesty about the situation.  In judging oneself, ask what you would tell a friend or loved one facing these same issues.

In behavior, look to what you could do when feeling well and what you can do that brings the things you want in your life.  Try to express how you feel, but above all, she urged, “Be patient with yourself.”  Routines may help one pull through.

Then there are the spiritual needs. Take part in activities that give meaning and engage with others meaningfully. 

Sometimes people need professional help in dealing with trauma or loss.  One question raised in the lecture was whether PTSD can be cured.  The answer was that in some cases it can be.  In others, there can be partial remission, with occasional flare-ups. 

Strive for hope if realistic, but otherwise we need to have courage and acceptance, for instance in case of terminal illness. 

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