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Recovery from Trauma
By Hwaa Irfan 26/11/2001
Although the events of September 11 were traumatic to an entire nation, regional health systems report that they have only just recently started to see a rise in psychiatric patients and increased levels of attendance at crisis centers. However, that is far from unusual. It is the very nature of Post-Traumatic Stress Syndrome (PTSS). Symptoms of PTSS take time to surface and even after the symptoms arise, it often takes people a long time to admit that something is wrong. Much of this understanding has been gained from the Oklahoma City bombing, and informs clinicians and other support services what to expect in the time ahead.
In the case of the Oklahoma City bombing some symptoms of PTSS were immediately obvious, while others only came to light years after the event. At the U.S. Housing and Urban Development Agency (HUD), where people had mourned and attended the funerals of 35 colleagues in two weeks, workers experienced survival guilt and significant reduction in their work performance in the weeks succeeding the event. Their symptoms included a failure to remember access codes to their computers and temporary amnesia in other areas of their lives (Jones, p.6). However, in the next four years after the Oklahoma City bombing, increased divorce rates, frequent alcoholism, early retirements, massive resignations, escalated domestic violence, and 30 suicides have occurred amongst rescue workers (Jones, p.14).
Immediate effects of the trauma are visible in New York as well. Although there is no way of telling what the exact long-term effects of the terrorist attacks will be, the short term effects are already haunting some people. After September 11 Molly Gabo is afraid to be alone with her thoughts at night and makes her husband wake up at 3.00 a.m. while she nurses their baby. Working on the 75th floor of Chicago's Sears Tower, she insists that he always carries a cell phone. In one day, in fact, Molly phoned her husband 800 times. Employees of other companies are also fearful. Employees of a national company that provides janitorial services to office buildings including the World Trade Center are now refusing to use elevators or enter tall buildings (Kluger, p.90, 91).
However, although the immediate effects of trauma are terrifying and often disabling, it is the long-term effects that have the potential to do more damage. This is because while recovering from PTSS, survivors may confuse the trauma with their personality or they may not be able to recognize symptoms or attach recognized symptoms to a particular event.
For this reason, the approach to dealing with PTSS is multi-disciplinarian. A psychosocial approach employs psychiatrists, health workers, social workers, nutritionists, lawyers, educationalists as well as family, friends and members of the community (Ochberg p.1, 7). The three stages of healing PTSS are:
1. The Normalizing Principle: This involves re-experiencing the event, avoidance, sensitivity and self-blame.
2. The Collective and Empowering Principle. This uses a collaborative therapeutic relationship that exercises the client's will, in order to overcome apathy. Victims might have experienced human cruelty, feelings of dehumanization and powerlessness. This stage of healing empowers the one who has a diminished sense of dignity and security - especially in victims of violent crime.
3. Individuality Principle: This emphasizes each person's unique path in life. This stage focuses on coping skills rather than the limitations in regaining control over one's life. Exposure to inspirational literature and information that explains the rights of the client is important. The clients may also have their own resources that can be shared with the clinician (Ochberg, p.2). Legal assistant Christopher Keith from Portland coped by doing Tai Chi and helping others. At the HUD, because workers were mainly Native Americans, the use of the sweat lodge involving family members, proved to be beneficial to all those who participated (Jones, p.10).
However, just as proper measures to deal with PTSS can be effective, improper measures can be equally destructive. Community Liaison Officer Joe Everett warns against the following "traps" of PTSS:
1. Isolating Oneself: The worst thing that one can do is to go into isolation (HealthWorld, p.2). Talking disarms the fear that can cause untold harm. In addition, gradual exposure to triggers of anxiety: like elevators, skyscrapers airplanes etc., help overcome the fear.
2. Not Taking Measures to Deal with the Problem: Sometimes complex emotions make one emotionally disabled. This is where Art Therapy can help greatly. Rather than become apathetic, art requires the use of the cognitive, perceptual and creative faculties and can address specific areas in a meaningful way. It helps to separate the emotions from ones identity, emotions that are too painful to express.
3. Avoiding Situations: Sometimes fear or trauma can trigger avoidance in people. This can interfere with normal physical, professional and personal relationships.
4. Eating Improperly: Sometimes fear or trauma can trigger an inability to perform daily functions such as cooking, shopping or eating. This can affect the biochemistry, interpersonal relations, self-esteem and the living connection to a victim's culture. The diminished diet of sufferers may contribute to anxiety, irritability and depression. . Experiencing emotional numbness may increase caffeine intake from candy, soft drinks, some desserts as well as coffee and tea. These effects overlap with the symptoms of the illness causing restlessness, nervousness, excitement, insomnia, flushed face, diuresis, gastrointestinal disturbance, muscle twitching, a rambling of thought and speech and changes in heart rhythm (Ochberg, p.8).
5. Re-traumatization: This can occur when the event is maintained in the public eye by the media. The Oklahoma City trials brought to life the horrors for the survivors; in addition to the relentless pursuit of stories from the survivors by the media. This can trigger a post-traumatic response and undo in a moment what has been achieved in hours of therapy (Jones, p.15).
The power of prayer is well known in surviving captivity and torture especially when faith is strong and alive. Recovery from the experience brings greater appreciation and respect for life in its fullness. Renewed understanding reprioritizes what is important. As Dr. J.A. Guiliano said: "The world leaders missed a pivotal moment in modern human history." In the wake of September 11 people stayed closer to home, spent more time with their families and brought home only what they needed. There would be fewer wars if this were the way people acted on a daily basis.
Sources:
Guiliano, Jackie Alan. "Spend, Spend. Spend." Environmental News Service. 10/07/01.
HealthWorld Online. "Simple Routine Cure for Tough Times." Health World Online. 10/18/01.
Idrisov, Kuri. "Post-War Psychological Problems in Chechnya." E-wtc.com.10/18/01.
Jones, John. G. "Mental Health Intervention in the Aftermath of a Mass Casuality Disaster." Indian Health Service. 10/18/01.
Kluger, Jeffrey. "Trauma." Time. 158:13(2001) 90-91.
Ochberg, Frank. M. "Gift From Within: PostTraumatic Therapy." Psychotherapy 10/18/01.
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