In addition to the host of difficult things all of us encounter in life, exposure to very terrible and traumatic events is also quite common. In this chapter, we will look closely at the impact of severe trauma and ways to cope in the aftermath of such experiences.

It is estimated that 50-90 percent of people in our country will be exposed to at least one very traumatic event in their lifetime (assuming they live a normal life span). Trauma is not simply defined as an encounter with a tremendously stressful or frightening event. What defines trauma is the experience of extreme powerlessness or helplessness when confronted with a very disturbing life event.

Such events include the following:

It was long held by mental-health professionals that traumas, by definition, involved exposure to life-threatening events or events that are relatively rare and outside the experience of most human beings. If you take notice of the previous list, some of these traumatic events are experienced at least once in a human lifetime. Especially experienced is the death of a loved one.

An erroneous assumption was made that the death of a loved one, although tremendously painful to experience, was not traumatic except under rare circumstances (e.g. suicide, murder, severe burns). However, a recent study (The San Diego Widowhood Project) discovered that among those losing a spouse, 10 percent developed post-traumatic stress disorder (PTSD): the most severe type of psychological response to trauma. The amazing finding was that this occurred even in those people who had lost a loved one to a chronic medical illness (e.g. Alzheimer’s disease, diabetes, congestive heart failure, cancer). Here the death was not sudden and often had been anticipated for months or even years.

Thus it does appear that many life events can potentially be experienced as traumatic, especially when they are accompanied by a feeling of helplessness or powerlessness.

Almost all human being are terribly shaken by exposure to awful life events, like those previously noted. Almost everyone will experience what are called intrusive symptoms at least for a few days following the trauma (in addition to grief or a host of other understandable emotional reactions). Intrusive symptoms are memories, vivid images, thoughts, and/or nightmares that are a replay of the terrible event. They are deemed intrusive because no one wishes to have these thoughts or images; they are profoundly upsetting. Without consciously choosing to think about the events, they simply pop into a person’s mind, usually accompanied by intense emotions.

For about 75 percent of those exposed to traumatic events, the intrusive symptoms go away in a few days. For a long time, of course, people have distressing memories, but not of this intrusive variety.

Also, many people experience a strong need to repeatedly talk about the traumatic event, even though doing so can be very upsetting. Psychologists believe that the automatic, intrusive experiences (including nightmares) and this urge to talk about the events are a part of adaptive and natural emotional healing. It is the mind’s way of repeatedly facing a horrible reality. At the heart of emotional recovery is this need to repeatedly think about and talk about what happened, until eventually some of the intense emotional charge of the experience begins to diminish.

The waves of very disturbing emotions, nightmares, and memories can really scare and destabilize people. Many individuals, at least in their private thoughts, are afraid that they must be losing their minds. It does not make common sense to feel this urge to talk about something so horrible or be repeatedly haunted by intrusive memories or dreams. Yet it is very important to recognize that this is simply the mind’s way to heal itself and once again find stability.

Another fairly common reaction to trauma is to experience what psychologists call dissociation . Dissociation is a state of psychological shock. People feel dazed, oddly numb, and devoid of what you might expect to be intense emotions. In this state, people often feel somewhat confused, report that they feel as if they have taken drugs, and may experience symptoms of derealization and/or depersonalization.

Dissociation can also feel crazy. The sensations are so odd and unfamiliar. People experiencing this type of psychological shock may be misunderstood by others. Other people may mistakenly think that the person is not distressed: either she must be handling it well, or for some reason, she must not care enough to be upset. These conclusions are absolutely inaccurate. Dissociation is an involuntary, automatic state of shock, very likely to be caused in part by significant changes in brain chemistry.

The incidence of post-traumatic stress disorder (PTSD) varies depending on the nature and severity of the trauma, for example, PTSD occurs in the following:

The symptoms of PTSD are severe and, by definition, last longer than one month. In addition to intrusive experiences and dissociation, most people suffering from PTSD also have severe anxiety/panic attacks, very severe insomnia, constant arousal, and hypervigalence (for instance, the sound of a car backfiring will produce a very intense startle reaction); many develop a marked withdrawal from life activities, experience depression, and are at high risk for substance abuse (especially alcohol abuse).

Over a period of time, many who have PTSD may spend time (maybe months) in intensely disturbing intrusive phases of the disorder (e.g. anxiety each day and nightmares each night). However, the intrusive experiences sometimes give way to marked dissociation, which can last days, to weeks, to months. And then intrusions can begin again.

Traumatic events can happen to any of us. If the symptoms are severe and last more than a couple of weeks, please seek treatment. There is a form of psychotherapy called exposure-based cognitive therapy that has a well- documented track record of effectiveness in treating PTSD. In addition, many people suffering from PTSD are successfully treated with antidepressants, in combination with psychotherapy.

At least 50 percent of people with full-blown PTSD will gradually recover without treatment. However, it is a painfully slow process that greatly interferes with one’s life. Also, those who do not recover can develop a much more severe, chronic version of PTSD that becomes very difficult to treat. Thus, once again, I must strongly encourage psychological treatment if symptoms continue past a couple weeks.

Many children growing up during the Cold War may recall disaster drills in elementary school, preparation in the event of a nuclear war. I really never thought that hiding under one’s desk at school would provide much protection. There was an ever-present threat that nuclear war could break out. Thank goodness it didn’t!

Since the terrorist attacks on September 11, 2001, many of us have a new thing to worry about. On the heels of that tragedy have been devastating earthquakes, hurricanes, and tsunamis.

Some people do develop a sort of PTSD by repeated exposure to upsetting media coverage of these disasters. Probably most people do not have actual PTSD, but do carry with them, at least on the back burner of their mind, this increased awareness that these devastating events can happen to them.

For many victims of 9-11 and hurricane Katrina, a lesson was learned. Most people directly affected did not need psychiatric treatment. What they needed was what came to be known as “doughnuts and information.” Donuts refers obviously to just that: comfort food, but it implies more. Handing out donuts to people in emergency shelters was one way to simply provide human contact. The other ingredient was information: generally, the more people could be told factual information about the disaster, the better. Human beings do not fare well with intense stress accompanied by confusion or ambiguity. People were comforted by being told exactly what happened (9-11), and finding out about their home and family members.

What most people exposed to trauma need are four things:

At the heart of psychological trauma is the shattering of many basic, human assumptions. Although we all know, at least intellectually, that bad things do happen to good people and the world is not fair, when tragedy and trauma strike, it can pull the rug out from beneath you. Many people may question their belief in God, or never again feel safe in the world. Nothing prepares us for these kinds of horrible life events.

Psychiatrist Scott Peck said, “The absence of fear is not courage … the absence of fear is some kind of brain damage.” Traumatic events scare the daylights out of people, and often they shatter our world. And people suffering more severe outcomes (PTSD), unfortunately, cannot simply forget it or put it out of their minds. Yet, there are ways to come to terms with life in the aftermath of trauma. Again, I must quote poet Robert Frost, “The best way out is through.”

The Least You Need to Know