
   1. What is trauma?
   The psychiatric definition of "trauma" is "an event outside normal
   human experience." Trauma generally leaves you feeling powerless,
   helpless, paralyzed. It tends to be sudden and overwhelming; it "owns"
   you. You cannot think clearly during and after a severe trauma; at the
   same time, you are forced to focus your consciousness in an attempt to
   deal. One author defines trauma as "any sudden and potentially
   life-threatening event."
   
   This refers to one-time traumatic events, but most of it applies to
   prolonged, repeated trauma as well.
   
   2. Some instances of one-time trauma.
     * natural disasters (earthquake, flood, hurricane, etc)
     * rape
     * assault
     * muggings
     * robbery
     * accidents (automobile, airplane, train, etc)
     * fires
       
   3. Some instances of prolonged trauma.
     * physical or sexual abuse as a child or spouse
     * war
     * life in a prison camp
     * life as a refugee
     * hostage situations
     * life in a concentration camp
     * life in some religious cults
       
   4. What are the immediate effects of single-instance trauma?
    1. Emotional
          + Shock, including numbed emotions, questioning of perceptions,
            memory disturbances
          + Denial, which helps reduce terror, helplessness, and fear of
            dying or being abandoned to manageable levels
          + Confusion and disorientation
          + Numbness
          + Panic
          + Weeping
          + Extreme anxiety and insecurity
          + Inflexibility
          + Dissociation, feelings of unreality
    2. Cognitive
          + Disbelief, another protective device
          + Disorientation and confusion
          + Difficulty thinking and concentrating
          + Unwanted thoughts -- traumatic memories may intrude on
            everyday living and in dreams, leaving you feeling out of
            control.
          + Perceptual problems
               o The world may seem unsafe, unsteady, unpredictable, and
                 unfair
          + Traumatic memories -- intense, clear, vivid images
          + Forgetfulness
    3. Hyperarousal
          + Trouble sleeping
          + Trouble concentrating
          + Heightened vigilance
          + Easily startling
          + Being wary
          + Sudden tears or anger or panic
          + Increased alertness and anxiety
    4. Body
          + Gastrointestinal symptoms
          + Headaches
          + Allergy symptoms
          + Menstrual problems
    5. The inevitable review
       Trauma survivors spend a lot of time thinking about what they
       could have done differently. Truth is, they couldn't have done it
       differently -- the body takes over. And the important thing is not
       what you did -- it's that you survived.
       
   5. What are the effects (immediate and long-term) of prolonged,
   repeated trauma?
   The immediate effects of prolonged trauma are the same as for one-time
   trauma, only they recurs with each new wave of traumatic experience.
   The long-term effects include Post-traumatic Stress Disorder, Complex
   Post-traumatic Stress Disorder, and a variety of mental and physical
   illnesses.
   
   6. What can be done to help survivors immediately after a trauma?
   Crucial to helping someone survive trauma is realizing that you, too,
   are affected by the trauma, that deciding to help is a big commitment,
   and that you need helpers, too.
   
   One of the best ways to help a traumatized person is simply to listen
   compassionately and actively, and make the person aware that you are
   willing to listen. Reassure the person that there are realistic ways
   to make it okay, that s/he can survive, that you are willing to help.
   
   Offer practical assistance -- running errands, cooking, whatever needs
   to be done. Don't just ask; if you see that something needs doing,
   suggest that you do it. This is much more effective than simply
   saying, "If there's anything I can do..."
   
   DO NOT criticize the person's reaction, minimize the trauma, suggest
   it was fate or God's doing, minimize the person's feelings, or say you
   know exactly how they feel (a very subtle way of minimizing feelings.
   Do not interfere with actions the person has chosen to take unless
   they are endangering self or others. If you think an action is too
   extreme, encourage the person to slow down and talk it through.
   
   7. What is PTSD?
   Post-Traumatic Stress Disorder (PTSD) is the name given to a cluster
   of symptoms often seen in trauma survivors. The more severe the
   trauma, the longer these symptoms will persist. In cases of major
   and/or repeated trauma, strong reactions may continue for years.
   
   Symptoms of PTSD can include:
     * Hypervigilance and scanning
     * Elevated startle response
     * Blunted affect, psychic numbing
     * Aggressive, controlling behavior (a high degree of insistence on
       getting your way)
     * Interruption of memory and concentration
     * Depression
     * Generalized anxiety
     * Violent eruptions of rage
     * Substance abuse
     * Intrusive recall -- different from normal memory in that it brings
       with it stress and anxiety
     * Dissociative experiences, including dissociative flashbacks
     * Insomnia
     * Suicidal ideation
     * Survivor guilt
       
   8. What causes PTSD to develop?
   The simple answer, of course, is trauma. But it's more complicated
   than that. During a traumatic experience, you adapt and choose new
   approaches that are survival-oriented for the situation you're in. The
   problem comes after the trauma, when those approaches and response are
   no longer functional. Recovery involves recognizing what responses are
   and aren't functional, and getting rid of the ones that hurt you. In
   effect, trauma reprograms your reactions very quickly; recovery is a
   kind of process of deprogramming.
   
   Some practitioners believe that trauma causes changes in brain
   chemistry, changes that are helpful in the short term by reducing the
   level of emotion to something bearable but that are harmful in the
   long term because they reinforce the PTSD symptoms.
   
   9. What can be done for PTSD?
   Healing begins when the survivor realizes that the trauma was real and
   had real effects on his/her life, not all of which are adaptive in
   terms of "ordinary" living.
   
   Trauma creates overwhelming fear and leaves in its wake a feeling that
   the world is not a safe place. Many practitioners (Herman, Colodzin,
   Miller, Hybels-Steer, Dee) thus believe recovery begins with
   establishing a safe place, a situation within which the survivor can
   feel some sense of safety and predictability. This usually involves
   developing an honesty about and awareness of the fear. As the fear
   subsides, the survivor is able to focus on other feelings and
   symptoms, to recognize them, search them for meaning, and decide
   whether or not to act on them.
   
   10. What is CPTSD?
   Recommended DSM diagnostic criteria, per Trauma and Recovery by Judith
   Herman, c1992 by Basic Books.
   
    1. A history of subjection to totalitarian control over a prolonged
       period (months to years). Examples include hostages, prisoners of
       war, concentration-camp survivors, and survivors of some religious
       cults. Examples also include those subjected to totalitarian
       systems in sexual and domestic life, including survivors of
       domestic battering, childhood physical or sexual abuse, and
       organized sexual exploitation.
    2. Alterations in affect regulation, including:
          + persistent dysphoria
          + chronic suicidal preoccupation
          + self-injury
          + explosive or extremely inhibited anger (may alternate)
          + compulsive or extremely inhibited sexuality (may alternate)
    3. Alterations in consciousness, including:
          + amnesia or hypermnesia for traumatic events
          + transient dissociative episodes
          + depersonalization/derealization
          + reliving experiences, either in the form of intrusive
            post-traumatic stress disorder symptoms or in the form of
            ruminative preoccupation
    4. Alterations in self-perception, including:
          + sense of helplessness or paralysis of initiative
          + shame, guilt, and self-blame
          + sense of defilement or stigma
          + sense of complete difference from others (may include sense
            of specialness, utter aloneness, belief no other person can
            understand, or nonhuman identity)
    5. Alterations in perception of perpetrator, including:
          + preoccupation with relationship with perpetrator (includes
            preoccupation with revenge)
          + unrealistic attribution of total power to perpetrator
            (caution: victim's assessment of power realities may be more
            realistic than clinician's)
          + idealization or paradoxical gratitude
          + sense of special or supernatural relationship
          + acceptance of belief system or rationalizations of
            perpetrator
    6. Alterations in relations with others, including:
          + isolation and withdrawal
          + disruption in intimate relationships
          + repeated search for rescuer (may alternate with isolation and
            withdrawal)
          + persistent distrust
          + repeated failures of self-protection
    7. Alterations in systems of meaning:
          + loss of sustaining faith
          + sense of hopelessness and despair
       
   11. What are the steps to recovery from prolonged trauma?
   According to Herman and Miller, survivors of prolonged trauma must
   first create a safe place. Herman considers the remaining steps to be
   remembrance and mourning and reconnecting with the world, accepting
   the changes that the trauma has made in your life. Remembrance and
   mourning involves grieving both actualities and potentials that were
   lost; reconnection is a time of "I know I have myself" -- a time for
   seeing the positive changes wrought by the traumas, celebrating the
   survivor self, and reconnecting/deepening intimacy with others in ways
   that were not possible before.
   
   Miller sees recovery in three stages, too: the outer, middle, and
   inner circles. The outer circle is a time for building safety and
   rapport and gathering basic information. Middle circle work involves
   focusing on current symptoms and how to handle them. Inner circle
   work, when trust is deepest, involves the sharing of shameful secrets
   and resolving the issues behind the trauma.
   
   12. How do I control and manage the symptoms while recovering?
   Many symptoms can be reduced and controlled simply by getting
   sufficient sleep and eating healthy, balanced meals. Nightmares can
   sometimes be controlled by use of a dream journal; rage and flashbacks
   can be prevented or reduced by recognizing triggers and avoiding them.
   Reducing your general stress level and finding self-soothing methods
   can also help.
   
   Depression and anxiety can sometimes be helped through medication
   (antidepressants, anxiolytics, mood stabilizers). Hyperarousal can
   also be helped by medication, and older tricyclic antidepressant are
   frequently used for insomnia.
   
   Ways to soothe yourself when anxious:
   
   Ritual: for example, a going-to-sleep ritual. Take a long, relaxing
   bath, put on comfortable clothing (if you sleep in clothes, and light
   a candle by your bed. Turn off the other lights. Stretch slowly across
   your bed, feeling your movements, feeling the sheets. Slowly open a
   book of poetry and read a page, meditating on the wisdom and beauty of
   the poem. Blow out the candle and go to sleep.
   
   Hide under the covers. Take the day off, make a nest of pillows and
   blankets somewhere. Turn off the phone. Scent the room. Make a tray of
   munchies, using your prettiest dishes, and find a good book. Do
   whatever makes you feel refreshed and relaxed, even if it's just
   huddling in your nest with munchies for a few hours. Allow the anxiety
   to bleed away.
   
   Ways to self-soothe when you are depressed:
   
   Hiding under the covers.
   
   Herbal baths:either make an infusion of herbs (like a very very strong
   tea) or put the herbs in small muslin bags you hang in the water
   stream or just drop in the tub.
   
   Suggested combinations:
     * 1 oz each of pine and peppermint
     * 2 oz rosemary
     * 1 tbsp ea of patchouli, geranium leaf, mint, orange leaf, sage,
       strawberry leaf, woodruff, and rosemary
     * 1 heaping tbsp ea of lavender, rosemary, comfrey, and thyme
       
   For more suggestions, see The Woman's Comfort Book.
   
   Bibliography
   Colodzin, B. (1993). How to Survive Trauma. Barrytown, New York:
   Station Hill Press.
   Dee, E. (1993). War Against the Silence After Trauma: Unmasking and
   managing the stress of change. Sioux City, Iowa: Loess Hills Press.
   Herman, J. L. (1992). Trauma and Recovery: The aftermath of violence
   -- from domestic abuse to political terror. New York: Basic Books.
   Hybels-Steer, M. (1995). Aftermath: Survive and overcome trauma. New
   York: Fireside.
   Louden, J. (1992). The Woman's Comfort Book: A self-nurturing guide
   for restoring balance in your life. San Francisco: HarperCollins.
   Miller, D. (1994). Women Who Hurt Themselves: A book of hope and
   understanding. New York: Basic Books.
   Shengold, L. (1989). Soul Murder:The effects of childhood abuse and
   deprivation. New York: Ballantine.
   
Other resources on the web for PTSD

   [1]David Baldwin's Trauma Pages
   
   [2]mentalhealth.com
   
   [3]http://www.long-beach.va.gov/ptsd/stress.html
   
   [INLINE]
   
  return to [4]SI main page

References

   1. http://www.sosc.osshe.edu/psych/baldwin/trauma.hmt
   2. http://www.mentalhealth.com/p00.html
   3. http://www.long-beach.va.gov/ptsd/stress.html
   4. file://localhost/usr/home/llama/Web/psych/injury.html
