The effects of trauma manifest in different ways between individuals. Some bury the experience deep within and those around them may never know of it. Others wear their trauma on their sleeve and it seems to inform everything they do. It may subtly direct their actions and relationships and their feelings of safety or power in the world. It may crop up suddenly and surprisingly under particular circumstances, triggered by some, event, memory, force or sense, unseen and unfelt by anyone else.
Our individual responses to trauma are influenced by many factors— the nature of the trauma itself; its intensity, duration, who it was perpetrated by— a parent, partner, stranger, country, or system. It is deeply influenced by an individual’s capacity for resilience and current stability of life. There is no doubt that whatever our response, trauma shapes our actions. And while the effects never wholly disappear, like a scar on our bodies they can fade and our relationship to the trauma can change. Many of us are able to transform a traumatic episode into meaningful change, sometimes even into art, writing or activism.
Mental health professionals often pathologize a client’s response to trauma based on their reading of “Trauma and Stressor Related Disorder,” the official diagnostic category of the DSM. While accurately describing symptoms of such responses, they unfortunately pathologize what can and perhaps should be considered very appropriate human reactions to terrible events, such as dissociation, physiological reactivity, intense or prolonged distress, and persistent, effortful avoidance of trauma-related stimuli. These symptoms, though at best unpleasant, are adaptive, even creative methods for handling incomprehensible events. They are our body and mind’s ways of processing something far outside the realm of our prior experience, a largely unconscious effort to protect ourselves from becoming overwhelmed with pain. The strategies that we use to cope with trauma are often called upon in other circumstances that may remind us of the event.
A young girl was repeatedly raped by a family member. As she ages, she finds that she avoids sex or else dissociates during the act, leaving her body emotionally and physically even though she may intellectually know that she is safe and loved. Still, something kicks in that she cannot control, a strategy designed to protect her from great harm and one that she developed as a child to deal the pain and confusion of her abuse. Does she feel frustrated with the fact that she is unable to be present or enjoy sex? Yes. Does this have the potential to negatively impact her relationship? Yes. But is it better than taking the risk of reliving the terror and helplessness and total violation she experienced as a child? Yes.
For many survivors, having their experience labeled as a “disorder” has an important side effect. It sticks to them as a life sentence— a cultural stigma that further contributes to their sense of hopelessness and despair. The diagnosis represents a quality of incurability rather than a healable injury, making it more unlikely that a survivor will seek help.
The Secondary Effects of Trauma
The DSM-V does, however, take the first step in acknowledging the ripple effects of trauma on the caretakers of survivors— the frontline responders such as doctors, nurses, EMTs, police and fire fighters, counselors, and sometimes teachers— who become immediately engaged with the crisis and provide sustained care for the survivors’ physical and emotional needs over time.
This reinforces the need for our culture to develop effective ways of working with trauma. Trauma impacts not just the survivor, but everyone around them including their families and communities.
When I tell people that I am a counselor I often get the same response: “I couldn’t do that. Listen to people’s sad stories all day. It must be so depressing and hard.” In fact in the beginning, I wasn’t sure I how I would handle it either. I wondered about the consequences of absorbing clients’ pain and confusion on top of my own emotional state day after day. Could I close my office door at night without carrying the weight of the world and all of its wrongs on my shoulders? I was afraid that it would change me— that I would become desensitized to suffering or perhaps crushed by the weight of it. That I would become numb to things that we all should be bothered by, or even that I would become suspicious of whether those around me were telling the truth about their pasts, their intentions, and their capacities for harmfulness.
But this has not happened. Instead, it has inspired me, which isn’t to say that I don’t sometimes I hear things that shake me to my core. Instead, in every client’s story I hear the same thing, the thread of life, the strength and fight we all have within us to keep going. The refusal to let an event or series of events that happened define who they are. The desire to heal and be well and be happy— the resilience of the human spirit.
But not all professional caregivers fare as well. Some do burn out, taking the sorrows of their work home with them. Why? One reason is that there is often inadequate support in their workplace. Many organizations, such as Child Protective Services, are short staffed and overwhelmed with cases. Caseworkers may have 30 children or families to manage, each in desperate need of attention and help. Rarely does an agency or supervisor provide the adequate support or resources for the caseworker in dealing with the emotional consequences of such intense and challenging work, or help them manage both the quality of care and also their own personal health. Rarely is there the time to simply pause and make them feel appreciated.
The same is true in many other public agencies– no one to talk to and no “breaks” to step away and regroup, to take a mere walk to get some fresh air in order to regain their internal balance. They are trapped in a system that keeps demanding more and more. Many suffer from compassion fatigue or the effects of secondary stress or vicarious trauma. The work that they do is not sustainable and never ends. It’s no surprise that many frontline workers develop symptoms similar to those who suffered a trauma firsthand. This is especially true with those workers whose personal traumas may have led them to work in a field with other survivors of trauma.
As providers, we are further bound by ethical codes that prevent us from sharing information told to us in confidence by clients. Thus, talking to our partners or friends is not an option or is only so if details are kept intentionally vague so as to protect the client. So what can providers do to navigate these challenges while remaining healthy?
We turn to our own therapists and also to peer support or consultation groups, something I have found to be absolutely necessary in my life and that I strongly encourage all helping professionals.
I also encourage all to speak up about the need for a healthy work place that both prepares and supports its staff to deal with the stress of daily secondhand trauma on both a local and a global level. To learn more about secondary trauma and compassion fatigue I highly recommend the book “Trauma Stewardship, An Everyday Guide to Caring for Self While Caring for Others” by Laura van Dernoot Lipsky.
We have found ourselves in a highly divided society. Those of us who have chosen a career in caretaking end up so often being a victim’s sole support, perhaps because culturally we are so uncomfortable hearing and responding to survivors’ experiences. Instead, we avoid talking about it by redirecting the conversation, or else by simply making ourselves altogether unavailable to those in pain. The message to survivors is to keep quiet: don’t make those around you uncomfortable, don’t burden others with your pain, avoid pity. By our inability to talk openly and honestly about difficult events, we further isolate the survivor, contributing to the confusion, shame, and loneliness they are likely feeling. When trauma is unacknowledged or silenced, a survivor’s natural pain is likely to convert to shame, anger, and sometimes violence. Some may even turn to substances to manage their feelings and start on the slippery slope towards addiction. In some cases, particularly when the trauma goes unexamined, survivors may be unconsciously drawn to people, relationships, and situations that are similar to the trauma in an attempt to reenact and correct what went wrong the first time— to produce a different outcome and symbolically gain control over past events. The risk for re-traumatization in these re-enactments can be high because they are not guided by conscious intention. When locked in this battle of life or death, intimacy and vulnerability cannot be readily accessed.
We must all become caregivers.
As a society, we must not only create institutional structures to provide outlets for trauma survivors and their caretakers, but we must all—family, friends, lovers, neighbors—also learn how to respond to trauma in loving and helpful ways. Compassionate listening does not require perfection or professional training. It requires selflessness and generosity. It doesn’t require that we fix the problem or make the pain go away. Instead, we listen openly without judgment or input. We allow the survivor to talk for as long as he/she wants giving them the message that we care and will be witness to their pain. We might encourage them to pause, take breaks, or breathe. It may be hard. It may be ugly. Hearing about terrible things happening to someone you know, someone you care about, usually is. But during these conversations it is not our feelings that matter most. Later, we can rely on personal methods of self-soothing as well as practiced patience, forgiveness, and compassion towards ourselves. We too can seek out a safe and supportive community to talk about our feelings.
Processing trauma verbally with survivors is a highly important piece of the recovery process, not only immediately following the event, but also over time as new memories and feelings arise. But the sad fact is that many traumatic events cannot be made sense of. Sometimes they are impossible to understand and our efforts to do so are futile. Even when we do succeed, insight can only get us so far. Trauma survivors may also resist reaching a place of understanding or acceptance because they believe it may somehow mitigate it and release the perpetrator from wrongdoing.
Learning to apply empathy is deeply important. Empathy is a sincere willingness to put ourselves in another person’s shoes— to try to understand what it means to be them and to recognize in doing so that we are not in fact so different. Applying empathy can facilitate the feeling of truly being seen and heard on the part of the survivor. It validates their experience of “pain” as understandable, rather than something they should “get over.” Thank the survivor for trusting you with their story and encourage them to continue to seek help with a counselor and support group.
But cognitive approaches involving talking and listening aren’t always enough. Why? Because the body reacts to trauma with a mind of its own— panic, shortness of breath, chest pain, exhaustion, aches and pains, and sometimes even physical immobility are part of the consequences. Beyond listening we can help a survivor feel supported through eye contact and, when we have their consent, we can gently touch an arm or hand during the time we are engaging them. The stress of trauma is often held in the body.
I have found over years of working with survivors that trauma impacts the body and can be released from the body by utilizing skills and practices that are somatic in nature.
We can alert a survivor to the benefits of focusing on their perceived body sensations that arise when under threat or stress in order to help them assess tools to manage the possibly instinctual or fixed physiological response states of fight, flight, freeze, or collapse. To read more about somatic approaches to healing trauma, look to Dr. Peter Levine’s, “Waking the Tiger, Healing Trauma,” or “In an Unspoken Voice, How the Body Releases Trauma and Restores Goodness.”
As caregivers, we must as take care of ourselves.
It’s difficult not to absorb some of the pain of those for whom we are caring. As caregiver, it is important to practice patience, forgiveness, and compassion towards ourselves and to not judge our feelings and responses as they arise. We must regularly check in with ourselves to see how we are feeling, making time throughout the week for our own self-care by doing whatever helps us ground and center ourselves–maybe through exercise, yoga, hikes outdoors, art, writing, as well seeking out a safe and supportive community of people with whom we can talk about our experiences. Nurturing ourselves gives us the positive energy to care for others and to participate in creating a world based on generosity and compassion.
Personally, I practice mindfulness techniques that have allowed me, over time, to stay present, avoiding an inclination to future trip or project more catastrophic scenarios. I am also conscious of creating balance in my life through work, creative projects, positive relationships, self-care, and time alone. I’ve learned to recognize and respect those signals in my body or thoughts that tell me I am “out of balance;” I make it a priority to regain it through practices such as yoga, meditation, exercise, and massage or through simple self-soothing techniques like stimulating my muscles and skin with my hands, with water pressure in the shower, or by other means. So much of our stress is absorbed by our bodies that I find that when I am more fully in touch with my body, literally and metaphorically, it helps me to center myself, giving me the energy and grounding to take on the next challenge.
With dedication to personal and societal change, we can heal, flourish, create, educate, and move things forward in a positive direction when it comes to healing trauma.