trauma
What is a traumatic experience?
According to the Diagnostic and Statistical Manual for Psychiatric Disorders criteria for Post-Traumatic Stress Disorder, a potentially traumatizing event is one in which an "individual experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others" (see DSM-IV, APA, 1994). The DSM criteria also specify a subjective response that is characterized by fear, helplessness, and/or horror. Research and clinical observation indicate that the range of events falling under this classification (e.g., physical or sexual assault/abuse; witnessing violence to others; sudden, unexpected death of a loved one; severe physical and emotional neglect) evoke several characteristic responses from the individual: a) the experience of extreme, overwhelming emotions (e.g., terror, helplessness, horror, rage, shame); b) heightened, sustained physiological arousal; and c) the shattering and/or distortion of basic beliefs and assumptions that are necessary for us to function optimally in the world (e.g., that there is some safety and predictability in the world, that the self has some power and worth, that some people are good and trustworthy).
To be traumatized is, by definition, to have the untenable happen; a victim is left with the almost insurmountable task of making sense of and coping with something that is overwhelming, beyond comprehension, inherently unacceptable. For example, a boy who watched his mother being beaten and raped experiences debilitating fear, along with incapacitating shame and guilt at not having rescued her (even in the case where any effort on his part would have been futile). He may be left with a profound sense of danger and lack of meaning in the world, along with a malignant sense of self, that may preclude his ability to form mutually satisfying relationships, find meaningful work. The potentially devastating impact of trauma cannot be overemphasized.
How to Help a Friend Survive
by Dr. Doug
My work as a professional therapist brings me into contact with many survivors of sexual abuse. Usually, these men and women present me with some other problem which is disturbing their relationships or their health. Mary (not her real name) is a good example. To the casual observer she looks confident, capable, serene, happy about life. She comes to deal with a relationship problem and some physical symptoms. As treatment progresses, she slowly reveals a very different side of herself. Her chronic stomach problems and headaches indicate repressed feelings of fear, confusion and anger. There is continual internal conflict and excessive anxiety. She worries about what is ‘normal’ and about small details of relationships and especially about her conflict with her father. One day she has a flashback of an abusive scene between her and her father. Then suddenly, a large bag full of sexual memories floods her awareness. She is panic-stricken, confused, angry and depressed all at once. Besides professional support, she needs extensive support from her friends. What can her friends do to help? Here are a few suggestions:
TAKE HER SERIOUSLY. Refrain from saying things like, “It’s probably not as bad as you think.” or “Is it possible you just imagined it?” This recreates a part of the abuse situation and makes her feel doubly traumatized and confused.
DON’T BLAME THE VICTIM. Children don’t invite abuse and they are not seductive. They don’t have the power, nor the psychological or legal capacity to consent.
LISTEN CAREFULLY. Empathic listening is very helpful at all stages of recovery. It does not fan fears, minimize concerns, or try to solve problems. Just “be there”.
This is another form of minimization; it encourages further denial and makes the road to recovery more difficult. Forgiveness may or may not be the end result of a process of struggle/grief/anger, etc.
UNDERSTAND how abuse is related to other compulsive habits like alcohol, drugs, obesity. These are old ways to try to stop the pain. Don’t feed into them. They worked then, but not now.
HOLD OUT HOPE BUT NOT EASY FIXES. There is healing from memories of sexual abuse. Putting a time frame on it or making it sound easy will usually be counter-productive.
BE SUPPORTIVE BUT NOT CONTROLLING. Survivors are prone to guilt and control, but neither of these lead to healing, however well-intentioned.
DON’T ENCOURAGE SECRECY. Telling a survivor to keep quiet about it makes him/her feel like appearances or the comfort of others is more important than how he/she is feeling. Secrecy is usually a part of the abuse and should be broken at the right time within a therapeutic plan.
ENCOURAGE GETTING PROFESSIONAL HELP. This can be done in a way that does not say “you’re crazy”. It is not an admission of failure. Getting help is a sign of being realistic and a sign of courage.
According to the Diagnostic and Statistical Manual for Psychiatric Disorders criteria for Post-Traumatic Stress Disorder, a potentially traumatizing event is one in which an "individual experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others" (see DSM-IV, APA, 1994). The DSM criteria also specify a subjective response that is characterized by fear, helplessness, and/or horror. Research and clinical observation indicate that the range of events falling under this classification (e.g., physical or sexual assault/abuse; witnessing violence to others; sudden, unexpected death of a loved one; severe physical and emotional neglect) evoke several characteristic responses from the individual: a) the experience of extreme, overwhelming emotions (e.g., terror, helplessness, horror, rage, shame); b) heightened, sustained physiological arousal; and c) the shattering and/or distortion of basic beliefs and assumptions that are necessary for us to function optimally in the world (e.g., that there is some safety and predictability in the world, that the self has some power and worth, that some people are good and trustworthy).
To be traumatized is, by definition, to have the untenable happen; a victim is left with the almost insurmountable task of making sense of and coping with something that is overwhelming, beyond comprehension, inherently unacceptable. For example, a boy who watched his mother being beaten and raped experiences debilitating fear, along with incapacitating shame and guilt at not having rescued her (even in the case where any effort on his part would have been futile). He may be left with a profound sense of danger and lack of meaning in the world, along with a malignant sense of self, that may preclude his ability to form mutually satisfying relationships, find meaningful work. The potentially devastating impact of trauma cannot be overemphasized.
How to Help a Friend Survive
by Dr. Doug
My work as a professional therapist brings me into contact with many survivors of sexual abuse. Usually, these men and women present me with some other problem which is disturbing their relationships or their health. Mary (not her real name) is a good example. To the casual observer she looks confident, capable, serene, happy about life. She comes to deal with a relationship problem and some physical symptoms. As treatment progresses, she slowly reveals a very different side of herself. Her chronic stomach problems and headaches indicate repressed feelings of fear, confusion and anger. There is continual internal conflict and excessive anxiety. She worries about what is ‘normal’ and about small details of relationships and especially about her conflict with her father. One day she has a flashback of an abusive scene between her and her father. Then suddenly, a large bag full of sexual memories floods her awareness. She is panic-stricken, confused, angry and depressed all at once. Besides professional support, she needs extensive support from her friends. What can her friends do to help? Here are a few suggestions:
TAKE HER SERIOUSLY. Refrain from saying things like, “It’s probably not as bad as you think.” or “Is it possible you just imagined it?” This recreates a part of the abuse situation and makes her feel doubly traumatized and confused.
DON’T BLAME THE VICTIM. Children don’t invite abuse and they are not seductive. They don’t have the power, nor the psychological or legal capacity to consent.
LISTEN CAREFULLY. Empathic listening is very helpful at all stages of recovery. It does not fan fears, minimize concerns, or try to solve problems. Just “be there”.
This is another form of minimization; it encourages further denial and makes the road to recovery more difficult. Forgiveness may or may not be the end result of a process of struggle/grief/anger, etc.
UNDERSTAND how abuse is related to other compulsive habits like alcohol, drugs, obesity. These are old ways to try to stop the pain. Don’t feed into them. They worked then, but not now.
HOLD OUT HOPE BUT NOT EASY FIXES. There is healing from memories of sexual abuse. Putting a time frame on it or making it sound easy will usually be counter-productive.
BE SUPPORTIVE BUT NOT CONTROLLING. Survivors are prone to guilt and control, but neither of these lead to healing, however well-intentioned.
DON’T ENCOURAGE SECRECY. Telling a survivor to keep quiet about it makes him/her feel like appearances or the comfort of others is more important than how he/she is feeling. Secrecy is usually a part of the abuse and should be broken at the right time within a therapeutic plan.
ENCOURAGE GETTING PROFESSIONAL HELP. This can be done in a way that does not say “you’re crazy”. It is not an admission of failure. Getting help is a sign of being realistic and a sign of courage.