Back From the Brink: A Family Guide to Overcoming Traumatic Stress, by Don R. Catherall, Ph.D.
Table of Contents | Introduction | Afterword
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BACK FROM THE BRINK:

A Family Guide to Overcoming Traumatic Stress

by

Don R. Catherall, Ph.D.

The Phoenix Institute

Chicago, Illinois

 

INTRODUCTION

 

Most of us have had traumatic experiences in our lives. Usu­ally, we're upset for a while, but eventually we get over them and life continues. But occasionally, some of us run into events that are so traumatic that we can't get over them with­out help. We still hurt and reexperience the trauma long after normal grieving should have ended. When this happens, we've not only been exposed to a painful experience, we've been traumatized by it. We feel decidedly abnormal and it may be quite some time before we come to feel normal again. This process is the trauma response. It includes not only the unpleasant experiences that we think of as traumatiza­tion but the period of healing and recovering from the trau­matization as well.

 

Various symptoms can follow a trauma. Some call these symptoms a disorder, even a disease. But whatever the name, these symptoms are a normal response to an abnor­mal experience. Like a scab that forms over a wound, a psy­chological trauma heals underneath a protective membrane that must eventually peel away. A large part of that protec­tive membrane is made up of supportive relationships with people who understand that the wound may not be visible but that the processes of hurting and healing—and the need for helping—are very real.

 

The duration, intensity, and severity of the trauma response varies with the individual. Some traumas are very high magnitude and will inevitably traumatize a large percentage of the people who are exposed. Other traumas may not be of such magnitude, yet some people are still trauma­tized by events that don't make much impact on others. But once the trauma response begins in a person, it must run its course. If the process becomes blocked, the per­son stays traumatized. And the trauma response is not lim­ited to the individual who was exposed to the trauma; it includes the people who are involved with that person. Those loved ones become part of the process, both the hurting and the healing.

 

Once you have been traumatized, you live in a world that's different from that of other people. The people who care about you will notice the change and try to help. But friends and family often don't know how to help. Loving and living with someone who has been traumatized can pull the helper into the survivor's traumatized world. As a result, the helpers can actually become traumatized themselves.

 

This book was written to help those people who have lived through the trauma directly and those who lived through it indirectly, through being the loved ones of a trauma survivor. My goal is twofold: to reach those who have been traumatized and help them learn to use their relation­ships with family and loved ones to overcome their outer isolation and inner turmoil; and to provide family or loved ones with tools to facilitate the natural healing process and help them in their daily task of staying emotionally involved with the person who is traumatized.

 

Post‑traumatic Stress Disorder

 

Modern society's awareness of the lasting effects of trau­matization stems primarily from the people who have been psychologically damaged in our century's wars and in the Holocaust. Traumatized combat veterans have been de­scribed with terms like shell shock, battle fatigue, and combat neurosis. Holocaust survivors were viewed as suffering from the aftereffects of such profound mistreatment as torture, degradation, loss, and dehumanization. Yet despite public awareness of groups such as these, the psychiatric community did not widely acknowledge the lasting psychological damage produced by traumatization until the late 1970s, when the diagnosis of Post‑traumatic Stress Disorder (PTSD) was introduced.

 

At that time, many of the traumatized veterans of the Vietnam War had gone undiagnosed for over a decade. Those who had sought help were frequently misdiagnosed, often being viewed as suffering from character or personality problems; their complaints about the effects of their war experience were frequently discounted. Their bizarre hallucinatory flashbacks even led some of them to be given extreme psychiatric diagnoses—such as schizophrenia—and to be treated with antipsychotic and sedating drugs.

 

In the 1980s, there was a sudden wave of interest in traumatization. I was involved in the Vietnam veterans' movement, and much of my own understanding of PTSD stems from that work. But what I have to say about traumatization does not apply only to war veterans or to Holocaust survivors. It's for everyone who's been traumatized, regardless of the specific nature of the trauma. Every trauma has its own unique meaning, but there is an underlying common structure to everyone's trauma response.

 

The Sources of Traumatic Stress

 

Once we understood that the symptoms of Vietnam veterans were the result of traumatization, we began to recognize this syndrome in people with many other types of trauma. This awareness was brought home to me when I was working with a group of parents whose children had been physically and sexually abused by someone outside the family. As I listened to the parents talk, I realized that they sounded exactly like a group of Vietnam veterans. They couldn't escape what had happened; it seemed to follow them around every day. They felt alienated from society, as if there were a wall between them and other people. They viewed people outside that wall as naive and superficial, not terribly concerned about the agony of their family. Their former friends seemed to have lost interest in these people as their traumatization dragged on for years.

 

That feeling of being different from other people is common to people who have experienced traumas related to war, to violent crime, to physical and sexual abuse, to life in an alcoholic family, to accidents and disasters, and to chronic and terminal illnesses. Each of these categories includes not only many different traumas, but many different ways in which people are related to the traumas. For instance, war traumas include not only those of combatants in the war zone, but also those of Holocaust survivors and their descendents, people who have been tortured, people who have lived in concentration camps or as prisoners of war, civilians in the war zone, military and civilian personnel who were exposed to the casualties of war, and the families and loved ones of all of these people.

 

Violent crimes—such as homicide, assault, rape, suicide, and terrorism—affect police, hospital personnel, and others who deal with trauma victims and their loved ones. People who live in abusive situations—battered wives, molested children, violent families—may leave the abusive situation itself but take the fears into their new families and create distrust. And the children raised in that atmosphere of distrust will be affected by their parents' traumatization.

 

Throughout history, natural disasters (earthquakes, floods, fires, tornadoes, hurricanes, plagues, droughts), manmade disasters (shipwrecks, plane/train/auto accidents, and nuclear and other industrial accidents), and chronic and terminal illnesses (leprosy, cancer, AIDS) have traumatized people and those who cared for them.

 

We've all been at least on the periphery of a trauma. Even people whose personal lives have been surprisingly free of trauma have still been affected by more distant events. We are all affected by things that happen to our community, whether local, regional, national, or global. Most Americans felt personally affected when President Kennedy was assassinated, when the Challenger blew up, or when Hurricane Hugo devastated the South Carolina coast. If we perceive ourselves as part of the community that suffers a traumatic event, we experience that trauma on a personal level too. This was most obvious when terrorists destroyed the World Trade Center in New York; people all over the country experienced themselves as part of that community.

 

When You Are Affected

 

Although you've probably experienced many such com­munity traumatic events, you probably weren't personally traumatized by them. But you or your loved one may have experienced a personal trauma. You may find an example of that trauma in this book, but you might not, since the exam­ples in the book represent only some of the things that people experience as traumatic.

 

What constitutes a traumatic experience is, to a degree, a subjective affair. If you feel personally damaged by the ex­perience, then for you it was traumatic. This is similar to the way people experience pain; some people can bear much more than others. Moreover, your feelings of devastation and hopelessness from a traumatic event depend upon the mean­ing you give that event. A trauma can produce a state of traumatization in one person and not in another because it holds a different meaning for each person.

 

It's important to distinguish between trauma and trau­matization. Everyone encounters trauma, but not everyone is traumatized. Traumas are relatively common life experi­ences, and there are well‑established mechanisms that we use to cope with the traumas we encounter. Some of those mechanisms work better than others, and some work better for some people than for others. People are traumatized when the effects of a trauma continue to disrupt or control their life, even though the effects may be buried for years before they emerge.

 

Five factors are involved in determining whether you'll be traumatized by an event. The first three factors have to do with how you experience the event, they are: the meaning you give it, your personal characteristics, and the actual na­ture of the event. Two more factors are involved in how you cope with the traumatization, your personal coping skills and the kind of help you get from other people. This book is meant to help you improve your coping skills and the help you give in your relationships.

 

Being the loved one of a trauma survivor is not easy. He has unusual needs; he needs to draw into himself and ex­amine the effects of the trauma on his feelings about himself and how he fits in the world. And at the same time he needs to feel connected and supported by caring people who under­stand him and what he's been through. You may find yourself trying to connect without imposing—a difficult balancing act.

 

For the trauma survivor, the natural healing process can become blocked, resulting in a breakdown in trust. When you don't trust people, you don't dare to open up. Healing normally goes on in a casual, everyday sort of way—between you and yourself and between you and others. But nothing happens if you can't trust. When trust breaks down, therapy can serve as a catalyst for the natural healing to resume.

 

Identifying Traumatization

 

You may be wondering whether you or someone close to you has been traumatized. The definition of trauma is some­what vague. Clearly, someone is likely to be traumatized when he or she has suffered an extreme life‑threatening ex­perience, such as a bad car accident or a wartime experi­ence. But people often describe non‑life‑threatening experiences as traumatic, such as a vicious divorce, an unex­pected financial disaster, or the premature death of a loved one.

 

What constitutes a trauma is not only the event, but how the individual interprets the event. If you're wondering whether you or someone you care about has been trauma­tized, here are some questions to consider.

 

If you think you may have been traumatized by an event or events:

 

·        Did some event interrupt and change your life for the worse?

 

·        When you think about that event, do you feel pain, anxiety, rage, guilt, or grief? Or is there a curious lack of emotion when you would normally expect to feel something?

 

·        Has there been a decline in the quality of your life since the event, either immediately after or at some later point?

 

·        Are you frequently reminded of the event? Does it occupy your mind more than you think it should?

 

·        Have you become isolated, less involved with other people than you were in the past?

 

·        Do you find it very difficult to trust people?

 

·        Are you troubled about what happened, still try­ing to figure out how you may have caused it or handled it differently?

 

·        Do you think about the possibility of it happening again?

 

·        Do you find that you are emotionally numb, unaf­fected by events that you know are disturbing to other people?

 

·        Do you have sleep problems? Have you ever re­sorted to drinking or working yourself to exhaus­tion in order to get to sleep?

 

·        Does your life‑style expose you to frequent risks?

 

·        Do you feel you're different from other people, that you don't really fit in?

 

·        Do you get depressed, have a drug or alcohol problem, or have problems maintaining your self-esteem?

 

If you think your loved one may have been traumatized:

 

·        Do you know of some traumatic event that she lived through that may have affected her?

 

·        Does some period or part of his life seem to lack detail or be missing altogether‑leading you to wonder if something happened then that left a mark?

 

·        Does she now talk as though her life is defined in terms of before and after the event?

 

·        Does he seem to have curious attitudes about talk­ing about it? Does it always come up in conversa­tion? Or does it never come up, no matter how close the conversation veers to the subject?

 

·        Does she leave you with a troubled feeling when she talks about the trauma, perhaps because dis­tressing things are being said in a very unemo­tional manner, or perhaps because she appears to be struggling to control a great deal of emotion?

 

·        Has he changed? Is he more volatile and difficult, or more withdrawn and distant?

 

·        Do you feel that she no longer trusts you?

 

·        Has the quality of your relationship changed? Is there an emotional gulf between you?

 

·        Have you lost that connectedness that is the essence of a healthy relationship?

 

·        Do you find yourself being pulled in different di­rections, wanting to spend time with her, yet find­ing that time to be so draining that you want to be away from her?

 

·        Do you find yourself preoccupied with thoughts of what happened to him?

 

If you answered yes to more than half of the questions in either category, you or your loved one may have been traumatized. In Chapter 1 of this book, you'll learn the specific symptoms of Post‑traumatic Stress Disorder (PTSD), and in Chapter 2 you'll learn more about the everyday experience of living with the disorder. After reading those chapters, you will be in a better position to judge whether you or your loved one is living in a traumatized state and perhaps could use some help with the healing process. If so, this book can help you make good use of the healing resources that are available to you.

 

People often expect recovery to return them to the level of functioning they had before the trauma. But reestablishing that level of functioning is not the same as getting back to your old self. One painful lesson about trauma is that life is never quite the same again. Those of you who have been directly traumatized—and many of you who were indirectly affected—are forever changed. But change is a part of life, and sometimes the final outcome of a traumatization is actu­ally for the better.

 

Organization of the Book

 

The book is divided into three parts; "Hurting," "Help­ing," and "Healing." Part I, "Hurting," has three chapters that describe traumatization—what it is, what it's like to have it and what it's like to be involved with someone who has it. A few technical ideas are introduced in this first part as well as in subsequent parts of the book. I've tried to pres­ent these ideas in plain English and not obscure them with jargon. When I resort to technical terms, I'll explain their meaning, and I hope they'll become a part of your vocabu­lary as you proceed through the book. Several important concepts—such as processing a trauma—reappear a number of times.

 

Part II of the book, "Helping," focuses on the process of overcoming the traumatization. Its first chapter gives an overview of the recovery process, while each of the others is directed to the various individuals involved: those who've been traumatized, those who are the loved ones of traumatized people, and the parents of traumatized children. Each chapter provides guidelines to aid you and your loved ones in helping each other.

 

Part III, "Healing," contains five chapters that focus on solutions to various problems and symptoms. They deal with physical symptoms (fatigue, stress, sleep problems), emotional symptoms (depression, anxiety, and reliance on alcohol/drugs), and interpersonal symptoms (isolation and poor self‑esteem). Chapter 10 describes rituals that can facilitate the healing and it includes guidelines for families to create their own healing rituals. Chapter 11 identifies some deep-seated psychological issues that underlie the way many people respond to traumatization. It can help you make a more informed decision about whether to pursue psychotherapy. The last chapter offers assistance in finding the right kind of professional help for you or your traumatized loved one.

 

Using This Book

 

This book is intended to provide you with a clear feeling for what the trauma response is really like. If you're working on your own or a loved one's recovery, it helps enormously to have a feeling for what you are trying to make happen and to know what it feels like when you do it right. For that reason, I've included many case examples throughout the book. I've used pseudonyms and changed certain identifying details to protect the privacy of the people whose stories I share, but they are all real people. Although I worked with most of them in therapy, I haven't emphasized the therapy in my discussion—this isn't a book about therapy, it's about the natural healing process and how to maximize it.

 

I wrote this book because I saw there was a need for it. I've given workshops, seminars, and classes on the topic of trauma, but my audiences have generally been other professionals. Many of the things I say are commonsense, practical advice that families and others involved with a trauma survivor can follow. I want to make that advice directly available to you, the people who can actually put it to use. This book can help you improve your coping mechanisms and deal more effectively with both minor and major traumas, but it isn't intended to replace psychotherapy. It may augment it and, in some cases, perhaps make it unnecessary. Some traumatizations are too severe for you to expect to overcome them without professional help. Don't be reluctant to seek such help, especially if someone is seriously depressed or behaving in a dangerous manner, such as sounding suicidal or abusing drugs or alcohol.

 

I've chosen to work with trauma because of the people I've met in the field, both as clients and as colleagues. There seems to be a high incidence of personal trauma among the professionals who've chosen to specialize in this field, and they invariably possess a sense of duty and strong commitment. I'm proud to be a member of such a group. People who have been traumatized know that the emperor has no clothes. They have a great appreciation for the fragility of life, the vulnerability of each of us. Some of them are still victims. Successful recovery means no longer being a victim. It means being a survivor.