Trauma and Resiliency

Trauma is an everyday occurrence in our world.  Everyone experiences it at some point or another.  Whether it’s something “normal” like an auto accident or surgery, or whether it’s something more unusual, like an attack, abuse, combat or seeing someone killed, it happens to a lot of people.  But most people recover fairly well, and don’t develop severe symptoms of PTSD.  Aftereffects are limited to a few days or weeks after the event, and people soon return to living their lives as before, at least mostly.  We say these people have more resiliency.

However, for many others, the effects last longer and are more disruptive.  They manifest as physical illnesses and sudden thoughts and feelings that can make normal functioning difficult, if not impossible. What makes the difference?  Why is it that two people who experience the same thing see such different results?

Differences that make a difference

Well, first let’s address that word same.  No two people are the same in terms of body chemistry, personality and life experiences or many other factors.  That means that no two people ever experience the same trauma in the same way.  Even if we’re sitting next to each other when the car goes into the pole, it’s not the same event for us.  And some of the differences can make all the difference in the world, in terms of resiliency.

First, there are differences in how things went down.  People who are able to do something about what’s happening, who are able to maintain some level of control, are not nearly as traumatized.  Perhaps you got away from one threat but succumbed to something else.  Maybe you were able to soften the blows somehow.  Perhaps someone came to your aid, or you were able to come to someone else’s.  These aspects of being in control are important.  The less control, the more severe the trauma.

Another thing that matters is how connected you are to other people.  The more positive personal and social relationships you have, the greater your resiliency.  Being able to call someone up, to share the burden of the event with others who care—this is important.  We are social animals, and social connections are a vital part of our mental health.  If you want to be able to survive the slings and arrows of outrageous fortune, stay connected.  (It’ll actually help you live longer, too.)

One more important thing—your history of previous unresolved trauma is important.  People who have experienced a lot of prior trauma seem to be more susceptible to being harmed by new traumas.  Things that might be a difficult bump in the road for someone with an ACE score of zero and a supportive group of friends and family can be overwhelming to someone with a score of four or five—especially if they are socially more isolated.  The bottom line is that life is very unfair in this regard.  People who’ve been badly hurt before are less resilient in the face of new traumatic experiences.

Getting in front of the problem

You can think of resiliency as PTSD pre-treatment.  It is preventative.  If we are more resilient we can do better regardless of what difficulties we face tomorrow.  So is there anything we can do about that?

The short answer is yes.  Let’s look at a few.

First, take control.  Perhaps we couldn’t avoid the car accident.  But what can you do now?  Finding a way to empower yourself in the situation is extremely important.  Regaining control helps us feel more normal after difficult events.  We can’t change the past, but we can do something to make today better.

Then, create and strengthen social connections.  This is extremely powerful.  Healing takes place in a context of social support.  And one of the unfortunate things about experiencing traumatic events is that sometimes they can interfere with our sense of security, and along with that, our willingness to trust others.  We also tend to isolate ourselves when we feel bad.  These reactions, while natural, just don’t help.  We need to find some people we can trust, we need to reach out for help.

One thing that can actually increase both of these (empowerment and connection) is to help others who have gone through similar circumstances.  Join a support group.  Volunteer. Collect donations.  Spread the word. This gives us a sense of control as well as connections with people we can relate to.  That’s a double-dose of resiliency right there.

Getting past the past

The last thing I’ll mention is also an important one.  We need to address the past traumatic events we have faced which have reduced our resiliency, our flexibility, our capacity to “bend in the wind.”  The past often isn’t really past, in terms of how it has impacted us.  If we’re functioning well, have some good times as well as tough ones, usually feel pretty happy with ourselves and our lives, that’s good—perhaps we can let sleeping dogs lie.  But many of us are far from that description.   Depression, anxiety, addiction, constant self-sabotage—these are signs that something is out of balance, even if we don’t have full-on PTSD.  It means that there is some work to do—not so that we dwell in the past, but so we can finally live free from its continuing harmful effects.

The goal of trauma treatment is just that—for the past to become the past.  A part of us, for sure, but a part that no longer frightens or paralyzes us.  The traumatic experiences become chapters in our story, just like all the other chapters, albeit not as sunny.  But once we[ve told the stories and written the chapters, once our bodies have really become convinced that the nightmare is over—then it’s time to get back to living a fulfilling life.  Work, love, serve and play.  That’s the point, right?

PTSD is not (exactly) an illness

Flashbacks.  Avoiding public places.  Hiding in the closet.  Jumping at sounds.  Nightmares.  Waking up shaking or screaming.  Yelling at loved ones for no reason.  Feelings of fear, anxiety, shame, rage.  These are some common symptoms of PTSD.  (Childhood trauma can manifest itself a bit differently.) There may also be depression, numbness, lack of ability to focus or concentrate and many similar symptoms.  People feel unreal, the world feels unreal.  But still, I’ll say that PTSD is not exactly an illness.  It’s not quite that simple.

How can anyone say that, especially when PTSD sometimes requires hospitalization?  Well, let me explain.  It starts with an understanding.  We are creatures with bodies and our brains are part of our bodies.  When bodies are injured, they immediately do several things.  First, they marshal protective resources.  If you are cut, the blood begins to clot.  The body may withdraw bloodflow back to your core (this is the physical reaction called shock).  Next comes inflammation—the body sends white blood cells to the site to fight any infection that may have intruded.  Finally, over the next few days or weeks, many restorative healing processes reconstitute the skin, the flesh and the blood vessels in the injured area.  Protection, then healing.  It’s what bodies do.

Protection

Traumatic stress occurs when our brains are overwhelmed with events that threaten us or those we are close to in some way.  The first thing we do under threat is fight or run.  If either of those works, then we’re usually pretty much ok afterwards.  But sometimes they don’t work.  Something is too much for our defenses.  The beating happens, the person is ejected from the car, the dog tears at the face.  When this happens, our brains protect us.  We dissociate, that is, we check out in some way.  Numbness, freezing, shutting down, forgetting, out-of-body experiences—these are the realm of the body’s defenses.  These are examples of defenses against threats that overwhelm our fight and flight responses.  If we can successfully fight, flee, or get help, we don’t need them. But when those strategies don’t work, our brains protect us from the too-intense experience of harm.

And as long as the threat remains active, the body (the brain) is in protection mode.  We do whatever it takes to survive.  But eventually the threat is gone (in cases of child abuse, domestic violence or imprisonment, this may take years).  Once we are safer, it’s time for the body to heal.  It’s time for the broken bone to mend, for the slashed skin and flesh to knit itself back together again.   So what does it look like when the brain is healing trauma?

Healing

In the last 50 years, we’ve begun to discover some answers to this.  We know, for example, that unhealed traumatic memory is very different from normal memory.  So the healing process must involve the brain constructing a normal memory of a situation that was unbearable at the time.  We also know that there is some kind of “charge” held in the body.  The body must somehow “ramp down” from its protective state back to a resting state.   This involves changes in physiology, in muscle tension, in the levels of stress hormones in the blood and many other things.

In the vast majority of people, the brain heals itself.  Some people are even stronger after the traumatic experience.  But some people do not quite heal on their own.  We don’t know completely why, but there are probably many reasons.  One is unresolved trauma from childhood.  Another is that the trauma might have been so massively overwhelming that the brain can’t heal just by itself.  There are other reasons and often we don’t know why.

So what then is PTSD?  A modern view is that it is nothing but a situation the brain’s attempts to heal that are stuck in one place–the brain is still trying to protect us, even though the event is over.  If you look at the PTSD symptoms, they are all about protection.  (The two major modes of protection involve being more agitated in some way, or checking out in some way.)  So there is nothing “crazy” or even wrong with a person who is suffering from PTSD, except for the fact that somehow, things are not healing (yet).  Like a scab that is constantly picked, like an unbandaged wound that keeps getting torn open, there is something that keeps the PTSD sufferer from healing naturally.  Some part of the brain doesn’t know that it’s over.

Supporting a natural process

The goal of trauma therapy is not fixing people who are broken.  It’s more like putting casts on broken bones, bandaging bad cuts, supporting immune responses with antibiotics.  We create a space for healing and facilitate the process.  Therapy puts a container around the wound and protects it.  Then we often jump-start the process, but then it unfolds of its own accord.  We try to keep from re-injuring it while that happens.

So in some important sense, PTSD isn’t quite an illness–it’s more like and unhealed wound–the body’s attempts at healing are stuck for some reason.   There are many things that can help—arts as simple as massage or as complex as acupuncture have been shown to be helpful.  And there are a number of therapies that can be very helpful in getting the process going.  But let’s be clear:  The therapy doesn’t completely heal the trauma, any more than the cast heals the bone.  The body heals, the brain heals, the person heals.

But sometimes, I have the privilege of helping.