Back From the Brink: A Family Guide to Overcoming Traumatic Stress, by Don R. Catherall, Ph.D.
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5

 

GUIDELINES FOR THE

TRAUMA SURVIVOR

 

Reaching Out/Delving Within

 

This chapter is for those who are actually trauma survivors. Whether you know it or not, you're already doing things to cope with your suffering. You're coping with daily stress, and with the symptoms and problems that your traumatization has produced. The things you're doing may be helping but not enough; worse yet, some of the ways you're coping may be producing additional problems.

 

Coping with Daily Stress

 

A stressor is something that produces stress. It may be the traffic on the freeway, friction with your boss, or the intrusive memory of a trauma. All of these produce stress, some more than others. When you encounter a minor or major stressor, you put your coping mechanisms to work. If it's a major stressor, you likely put more of them to work, including those you don't often use in dealing with the minor stressors. We all have those coping mechanisms that we rely upon regularly, and we have others that we maintain in reserve for major stressful events, such as the loss of a loved one.

 

Many of the coping mechanisms you use for minor stressors in your daily life are limited in their power. They are not adequate for major stressors, providing short‑term help at best. You get into trouble if you try to stretch some of these minor strategies to fit situations that are too much for them. These daily mechanisms are very important, to be sure—they're the foundation of your coping style, and they reflect your basic attitude about how you view and deal with stressful events. Some people confront stressors, while others avoid them. You probably do some of both, but if you always avoid daily stressors, you'll be at a disadvantage in dealing with major stressors.

 

Your Coping Style

 

At this point, stop and take the time to assess your own coping style. Write down a few sentences that describe your approach to dealing with stressors, both major and minor. Here are some questions to consider:

 

·        What are your predominant attitudes about daily stress? Is it best to confront it or avoid it?

 

·        What kinds of things have you done in the past to deal with major stressors? Have you ever numbed out? If so, how much? Have you ever been a sensation or arousal seeker, or put yourself in situations that recreate your trauma? Again, how often? Have you ever pursued a program of self discipline? If so, how far did it go? Was it useful?

 

·        How much have you effectively used recreation, relaxation, or exercise to deal with stress?

 

Your coping style is strongly influenced by your family background. Stop and think about it—what's your family's coping style? Here are some more questions to consider:

 

·        Do you come from a family that encourages ig­noring daily stresses? Or does your family help you recognize and anticipate life's problems? Do they accept problems as challenges?

 

·        Is it acceptable to talk about problems in your family, even little ones? Or is it frowned upon and viewed as whining or feeling sorry for yourself?

 

·        Think back to your family's unwritten rules about expressing emotion. Is it really permitted to get upset about something that happens to you?

 

·        How does your personal coping style mesh with your family's unwritten rules?

 

·        Are you still following the same rules you grew up with, or have you reacted against some rules by trying to live very differently?

 

There are as many ways of coping with daily‑life stress as there are kinds of people. But there are some common patterns, and you're likely to approach traumatic stress in one of these ways. Here are some of the common attitudes people adopt toward daily stress.

 

Ignore It

 

One of the most common ways of dealing with stress is to do nothing whatsoever. Act as if it doesn't bother you, and the theory is that it won't. This is the John Wayne approach, strong and silent. You probably use this coping mechanism sometimes since the best way to deal with many of life's mi­nor stressors is, in fact, to ignore them. But pretending that a major stressor doesn't bother you generally doesn't work—major stressors are hard to ignore. Ignoring them (stoicism) can block the all‑important processing that is needed in the case of trauma.

 

Forget It

 

Another coping mechanism that you probably use is to try to forget what happened. Sometimes people are able to leave traumas behind them. Even in major traumas, most people have a healthy tendency to forget things that are too disturbing, such as the grisly details. Over time, you're able to forget many aspects of a major trauma. You generally don't forget that it happened, but you're often able to forget many of the little memory cues that bring back the worst of it.

 

Sneer at It

 

Some people regard life's stresses as a challenge and respond to them by becoming aggressive and competitive. This is a way of dealing with the trauma directly, rather than avoiding it by ignoring or forgetting it. Football players sneer at and ignore stressors when they overcome minor injuries and go back on the field to win. The spirit behind this atti­tude can get you through many a jam, but you need more than this to deal with a serious trauma.

 

Laugh It Off

 

A sense of humor is one of the blessings we've been given to deal with the frustrations and disappointments of life. It plays a part in helping us change our perspective and reduce the sting of events. It's one of the very best coping mechanisms you can have, but it's still only one of a number of mechanisms that you need in order to deal with a major trauma.

 

Talk About It

 

Many people cope with daily stress by talking about it and sharing their feelings about it with others. This serves to decrease the pressure they're under and provides the opportunity for a change of perspective. Talking about stress is a mainstay coping strategy; you can use it with the smallest stressors and the major ones. It's primarily through talking that you examine and change your perspective. It's also through talking that you express your feelings and, in the process, come to understand them more clearly yourself. Through talking with someone you trust and care about, you can process and ultimately come to terms with traumatization.

 

Coping with Traumatic Stress

 

These basic attitudes about daily stress influence how a person will approach major forms of stress. In general, people need more powerful, long‑term coping mechanisms when they are dealing with major stressors, particularly when they've been traumatized. The following are some mechanisms that people commonly use to deal with a trauma.

 

Numbing Out

 

Most people numb out their emotions and stop feeling them at some point in dealing with traumatic stress. But doing this creates a host of other problems. Since numbing out is difficult for some people, they may resort to drugs and alcohol to help them numb out. Once you've numbed out sufficiently, you carry an emotional deadness inside; then you resort to further problematic mechanisms to overcome the deadness.

 

It is sometimes adaptive to be able to numb out, and people who function at a high level in crisis situations are usually good at numbing. But it becomes a major symptom of PTSD if it goes too far.

 

Sharon was an emergency‑room nurse who overdid her emotional numbing. When she started ER work, she learned to maintain emotional distance in dealing with trauma victims. Sometimes she and the other ER staff would even gather in the staff lounge and make fun of the misery of the traumatized patients. Sharon initially found this to be cruel, and she held back during the joking. But after a while, it didn't seem so bad to her, and she found she was comfort­able with it even though she still cared deeply about the people she treated.

 

Then Sharon's hospital was elevated in the trauma net­work of major hospitals in her city. The hospital nearest hers closed down its trauma services, and suddenly Sharon's ER was barraged with additional patients, including many vic­tims of violent crime from a part of town that the other hos­pital had previously served. Her job changed its character. Every shift was enormously draining; everyone felt over­worked. For Sharon, it meant exposure to many more, very severe injuries.

 

Sharon found that the depth of her feeling for the pa­tients became shallower. She became hardened, and the hu­mor in the lounge was no longer funny—there was a bite to it that hadn't been there before. Sharon and many of her col­leagues had become emotionally numb, and she even devel­oped a drinking problem. A therapist recognized that she'd been traumatized and helped her stop drinking. Sharon then transferred to a different section of the hospital and recovered her emotional spontaneity.

 

Sensation‑Seeking

 

Sensation‑seeking is a means of coping with the dead­ness that comes from excessive numbing out. Sensation ­seekers and "adrenaline junkies" pursue high‑risk activities to give themselves a jolt to overcome their lack of feeling. They may work in high‑risk professions, have high‑risk hob­bies, or lead dangerous lives. We all enjoy some occasional excitement in our lives, but sensation‑seekers' lives center on getting that excitement. Without it, they feel empty and de­pressed. The following example of a sensation‑seeker may seem exaggerated, but there are a surprising number of trauma survivors who live just like this man.

 

Sam was traumatized in Vietnam. He was in bitter fight­ing and faced death a number of times. Back in the States, he became a policeman. He always managed to be involved in the more severe incidents, and he fought with several desper­ate criminals. In his off‑duty hours, he rode a motorcycle, drank heavily, and often got into fights at bars, usually with much bigger opponents. His hobbies were whitewater kayak­ing, rock climbing, and sky‑diving. Seldom did a week go by when Sam didn't have a major adrenaline rush over some­thing, much as he had during his perilous tour of combat duty. The risk‑taking nature of Sam's sensation‑seeking may represent more than just an effort to overcome inner dead­ness. Many sensation‑seekers also have survivor guilt (see page 55) and are testing their fate and punishing themselves.

 

Arousal‑Seeking

 

Arousal‑seeking includes not only sensation‑seeking but less risky activities as well. Arousal‑seekers work to keep themselves on an adrenaline high. Some work at an intense job, while others resort to drug use, sexual addiction, and fighting. They use the arousing quality of these experiences either to keep themselves from feeling deadness inside or to find outlets for the state of hyperarousal that their trauma­tization has produced.

 

Marian, who was physically and sexually abused by her mother's boyfriends and a stepfather, grew up feeling dead­ened inside. As an adolescent, she used every drug that came along and became particularly fond of amphetamines, which gave her a feeling of being very up and intense. As an adult, she relinquished most of her drug use, but became obsessed with sex and slept with several men each week. She couldn't tolerate sitting around her home and went out virtually every night. She eventually got control of her sexual behavior but became deeply involved with her career, working long days and taking little time to herself. One way or another, this arousal‑seeker always kept herself going at a high pitch.

 

Pursue a Program of Self‑Discipline

 

Many people stave off the effects of traumatization by undergoing a self‑imposed program that requires high levels of self‑discipline. It may be an exercise program, a work project, or an intensely preoccupying hobby. When Marian went from purely arousing activities to an intense investment in her work, it allowed her to focus her high level of energy, but she was still burning herself up. There's a fine line be­tween a healthy program of self‑discipline and an obsession that runs your life.

 

Chris grew up in a violent, alcoholic family. Her father beat her when she disobeyed or challenged him about his drinking. She also saw him beat her mother several times. She never felt protected in her family. Chris coped by becom­ing highly involved in athletics at school. She was quite driven in her devotion to practice and became an accom­plished gymnast, which eventually earned her a scholarship. After college she moved away from her family. But she con­tinued to pursue athletic activities to such a degree that it created new problems. When she damaged her knees by run­ning enormous distances each week, she switched to swim­ming and tennis. When she gained weight in her late twenties, she became obsessed with her diet and nearly starved herself. She eventually went to a program for eating disorders and learned to be less rigid in her pursuit of pro­grams that were supposed to make her feel better.

 

Relive the Trauma

 

Some people work to overcome the effects of trauma­tization by exposing themselves to the trauma repeatedly until it loses its power over them. They may be so intent on doing this that they go out of their way to recreate and relive the trauma. Whenever they encounter a situation that re­minds them of the trauma, they feel compelled to enter the situation and master the feelings it evokes.

 

Emma's father drank and beat his wife and children. She left home when she was eighteen years old by running away with a boy and getting married. The marriage lasted less than two years; after that, Emma became involved in two different relationships with men who battered her. She left each of the men and went to live elsewhere several times, but she invariably returned to the men who mistreated her. She felt she could help these men overcome their tendency to beat her by becoming more accepting and understanding of them. Only after she realized she was still trying to change her abusive father was she able to feel appropriately fright­ened, leave these abusive men, and get involved with a non-abusive man.

 

Dealing with the Meaning of Your

Trauma

 

These mechanisms are some common ways people deal with the disturbing emotions stirred up by their traumatiza­tion. You probably recognize some of them yourself. But ultimately, you must deal with the meaning of your trau­matization. Only then will you come to terms with it and be able to live with it. Here are some of the ways you can make sense of what's happened to you.

 

Change Your Perspective

 

We often overcome our upset at one of life's obstacles by telling ourselves that it's not such a big thing. This coping mechanism is reflected in the aphorism, "I cried because I had no shoes, until I saw a man who had no feet." By chang­ing your perspective on the severity of the trauma, you change its meaning and therefore diminish its power over you.

 

While Judy was looking for work in the field of model­ing, she was involved in an automobile accident that resulted in a nasty scar on her face. Naturally, she felt her life was ruined. She became depressed and bitter and lost her moti­vation, saying that this was God's way of telling her that she was too vain and that now she would be forced to know what it felt like to be ugly and to envy the beautiful people. Judy's family talked her into getting plastic surgery. She had two operations, and both times she criticized the results. Al­though the surgeries brought some improvement, they didn't make the scar invisible.

 

One day, one of Judy's old high school girlfriends talked her into helping out at the day‑care center where she worked. Judy discovered she enjoyed working with children, perhaps in part because some of them openly asked about her scar but didn't seem to be put off by it. Her interest grew, and she eventually sought a degree in early childhood educa­tion. She had found a goal that gave her life meaning once more.

 

Today, Judy is happy; she isn't obsessed with her scar or what happened to her. She no longer feels that the accident was meant to teach her anything. She still wishes that it had never happened but adds that it may have been a blessing in disguise. Although when it first happened, she felt she was ugly, now she doesn't think so. She looks in the mirror and sees herself, not her scar. And the blessing is that now this is how she looks at other people too. In coming to terms with her traumatization, Judy's perspective has changed, and she has grown.

 

You can work on changing your perspective by doing the following:

 

·        Talk to someone you trust. Is there anyone you can talk to who has been through a similar experi­ence? Whoever you talk to, let them know how you feel, how you view what's happened to you.

 

·        If there's no one with whom you can talk about these things, find a good therapist. (See Chapter 12 for guidelines).

 

·        Verbalize the questions that are plaguing you. See what answers others might have for those ques­tions. Their answers don't have to be your an­swers, but they may bring you a new perspective.

 

·        Tell the people you trust about your losses. Accept their support. Don't pretend that it doesn't mat­ter.

 

·        Explore the ways you've changed. Who were you before? Who are you now? What are the things that make you feel good about yourself? What makes you feel bad about yourself?

 

·        See if you can describe your worldview. Take some time and spell it out in detail. How has it changed from what it was before?

 

·        What have you learned from your traumatization? What would you now want to teach your children of your experience?

 

·        What benefits? What do you have now that you didn't have before?

 

Strengthen Your Belief System

 

One common result of traumatization is that people's belief systems change. Existing beliefs become stronger, or new beliefs may replace old ones. This can give you greater strength to cope with both the primary and relational trau­mas.

 

Many people find religion as a result of being trauma­tized; of course this is not the only way a person might change his beliefs. Traumatization causes you to ask ques­tions—about yourself, your life, even the meaning of existence. You need solid answers when you've been trau­matized, not superficial ones. You may come up with the same answers you had before, but they're probably more deeply thought out. Or you may have to find answers to ques­tions you really hadn't considered before.

 

Beliefs are often strengthened when a person is recover­ing from shattered illusions and is consciously reexamining his or her most basic beliefs. It's not so much a coping strat­egy as a by‑product of the process of examination. But as beliefs strengthen, they contribute to a person's emotional equilibrium as well as his intellectual stability.

 

Harriet was eighteen years old when her father lost his temper and became violent in an argument with her mother. He struck her mother with a heavy object and killed her. Harriet hadn't known him to be a particularly violent man, though his temper had always been very hot. When it happened, she was away at her first semester of college, so she didn't directly witness the violence. But the trauma for Harriet was the sudden loss of her mother and the knowledge that her father had done this horrible thing. Her life was turned upside down. She dropped out of school and went to live with some of her mother's close relatives. Just about everyone she encountered viewed her father as evil and discouraged her from seeing him at all. But it was not so simple for Harriet. He was still her father, and now he was the only parent she had.

 

After eight months, she decided that she needed to visit her father. Several years later, she continues to visit him in prison. Her feelings about him have been all over the map, but she refuses to write him out of her life entirely. She was uncertain about this for some time, but finally she came to believe there was something worthwhile and redeemable about him. She seems to have found some answers to her question about how he could have done what he did to her mother. She realized that he'd always had the potential to do such a thing but that she'd simply made herself believe that it wasn't so. Now her naiveté is gone, but her belief about her father's underlying worth survives. Harriet's beliefs about people in general will never be the same, but she feels she has a grasp of human nature that better prepares her for the worst, yet still lets her enjoy the good in others.

 

Devote Your Life to a Cause

 

Many people handle a major traumatization by devoting their lives to a cause, usually one related to the trauma. Organizations such as Mothers Against Drunk Driving are formed by trauma survivors or their loved ones (who are also trauma survivors). Many former addicts devote their lives to helping other addicts kick their habit. And survivors build memorials, such as the Vietnam Veterans Memorial in Wash­ington, in hope of helping other survivors. All these groups give meaning to their lives by helping others. Many trauma­tized people become crusaders in order to bring meaning into a life that might otherwise feel meaningless. But orga­nized causes are only the more obvious examples—there are also causes that aren't as obvious. Here's an example of someone finding a cause as a way of bringing meaning to her traumatization.

 

Angela, a clinical psychologist who specializes in "women's issues," is very concerned with "giving women their power," helping those women who've been abused ­physically or emotionally by others, particularly men. She knows that her desire to help the underpowered women in the world stems in large part from her own abuse as a child. She doesn't want anyone else to have to live through what she's experienced. She's given her life meaning by helping others avoid the trauma she endured. In a sense, this allows her to attribute a positive meaning to her own abuse because of the good it's enabled her to do for others.

 

No one coping style works for everyone. You must start from the kind of coping style you already have and think about ways to improve upon it. Finding causes and deep be­liefs is not for everyone, but everyone does need to change their perspective. You must take the time to think about what you believe in and what gives your life meaning. You'll prob­ably find that it helps to have someone with whom you can talk about these things—just thinking about them isn't so easy. When I was a freshman at Texas A&M, we weren't per­mitted to "think" about things; we were told we could only "cogitate." Cogitating means to take careful and leisurely thought, to meditate or ponder, to consider intently. I sug­gest you "cogitate" about the meaning of your life. Here are some tough questions for you to ponder:

 

·        What are the most important things in your life? Are they things that you already have or do, or are they things that you're striving to attain? If you're not striving for them, why not?

 

·        What are your priorities?

 

·        Do you feel there is a spiritual dimension to life? Are your spiritual needs being met?

 

·        Who are the most important people in your life? Have they always been, or have the important people changed over time?

 

·        What are your personal strengths? What about your weaknesses? Have these changed? If so, what strengths have you lost? Are there things you can do to get them back?

 

·        How do you think you're seen by others? What do they admire about you? What do they see as your weaknesses? How would you like to be viewed by others?

 

·        Who do you consider to be people who are living their lives meaningfully? What prevents you from living your life more like them?

 

·        Is there a purpose to life, to suffering, to loss? How do you account for the existence of terrible things, such as the trauma that you've suffered?

 

·        How do you feel about yourself? Are you the kind of person you want to be?

 

·        Where do you fit in your view of the world? Are you making a contribution?

 

It can be helpful to project yourself into the future in order to obtain a better perspective on the present.  Here are some questions that you can consider:

 

·        When you think about the latter stages of your life, what do you hope to be doing, to have done? What kind of person do you hope to be?

 

·        Imagine yourself at the end of your life. Now look back and think about your trauma response. How did it change your life? What more positive place could that change have led to? How might your trauma response have evolved, both in a more positive direction and a more negative direction?

 

Processing Your Trauma

 

As you evaluate yourself and your use of coping mecha­nisms, you will develop a picture of how you're dealing with your traumatization. You may feel that you're dealing with the symptoms part of the trauma response, but not moving forward with the healing because your perspective has not changed and life feels meaningless. If so, you must closely examine your coping mechanisms. These are what you have the greatest control over! Ask yourself whether you're coping in a manner that allows you to process the trauma—or only contain it.

 

What exactly is processing the trauma? Processing is an internal experience in which you examine and reflect upon your feelings, attitudes, and beliefs. It's the process of change. It's usually accompanied by conversation, but the processing shouldn't be confused with the conversation.

 

It's in your feelings that processing takes place. You con­tinually process feeling states. When your interests or tastes change, you've processed some feelings. Some feelings are much stronger than others, loaded with emotion and hard to change. Feelings related to your traumatization are very strong. But even strong feelings change. The strength of the emotion underlying most feelings fades over time—and fac­ing fears can help diminish their strength.

 

So look at your coping style and decide whether it's al­lowing you to process your traumatization. If not, what needs to change?

 

Reaching Out/Delving Within

 

As you alter your patterns of coping in order to facilitate your processing, two things need to happen. First, you must find the time and opportunity to delve within and find an­swers for the questions your traumatization has created. Sec­ond, you must reach out and make better contact with your world and the people who populate it. These two events weave around and through one another—often you delve within by reaching out and talking to someone about your inner feelings, beliefs, and attitudes. It's hard to simply talk about feelings, beliefs, and attitudes; you discover those parts of yourself through talking and thinking about events in your life.

 

It's important that you and your loved ones have similar attitudes about the necessity of talking. If you don't, then trying to talk will create new tensions. Don't be too quick to assume that you know what your loved ones' attitudes are, much less your own. Just because no one has been talking doesn't mean that no one wants to. Many families remain silent because each member thinks that this is what everyone else wants. Your first step may be to ask your loved ones how they feel about the whole idea of talking.

 

The events you need to talk about may be the primary trauma or other aspects of your life that provoke strong feel­ings. Some people will need to talk explicitly about the trauma. Others will find that they and their loved ones com­municate in other ways and don't feel it's necessary to talk about the trauma per se. You may or may not feel it's neces­sary to talk about the frightening details of your trauma, but even if you do, not everyone has to know them. What is more important is that they understand what you're upset about. As long as you feel understood, you've made the connection you need to process your trauma. If you don't feel under­stood, speak up. That's where the work begins.