Dealing with Trauma

The UK is traumatised. The Grenfell Tower fire in Notting Hill, London, terrorists at London Bridge and in Manchester. People have seen and experienced things beyond the norm. Lives have been lost and people displaced, but some of the focus is now moving onto the survivors and witnesses - and their mental health. There is talk of counselling and debriefing - but what does this mean, and how can the church help?

 

What is PTSD?

Those involved will currently be 'post-trauma' - that is, they will be in the period after seeing something traumatic. They will be experiencing flashbacks and fluctuations in their emotions. Different parts of their memories - the pictures, the sounds, the smells - will be all jumbled up and fragmented.

But this is a normal reaction. Their brains have just received a massive input of information that they were not expecting and have not experienced before and so do not know how to process. So, the information is currently kicking around in the brain's 'inbox' - and is all mixed up. However, over the coming weeks, for most people this will be processed. They will be able to restore the timeline - to know they were at risk and are now safe; they will be able to join up the sounds and pictures to make a movie that they can 'file away' in the past.

The memories will always be there, but they will be correctly processsed and stored. Occasional triggers, such as a news item, may cause things to resurface - but generally speaking their brains will settle back down. This is memory working correctly - though at this particular 'post-trauma' time it all looks a mess.

For some, this processing will not occur and the memories will remain fragmented and out of order - still in the 'inbox' and not 'filed' in the past. If this goes on for more than a few weeks (the technical cut-off is 4-6 weeks), then this is sometimes called PTSD - post-traumatic stress disorder. This is more likely in situations that are outside our normal frame of reference or occur out of the blue - such as a terror attack or a fire or an earthquake. It is also more likely when things seem unjust - more of this below.

 

PTSD is defined as a triad of three symptoms:

• Flashbacks or nightmares: unbidden images or experiences occurring several times a day.
• Avoidance and numbing: being unable to go back to the place, throwing yourself into something else.
• Being 'on guard': an overactive adrenalin response, jumping at the smallest noise, struggling to sleep.

Other more general symptoms of anxiety and depression may also exist. If PTSD becomes established - so after one month - that is the time for formal help - which should take the form of Cognitive Behavioural Therapy and, for some, medication. The medication can help reduce the adrenalin response so that CBT is even possible, and can help with additional symptoms of anxiety and depression, however it is CBT for PTSD which will help process the memories that have got stuck.

One analogy is of trying to put a duvet away in a cupboard. If you just shove it in and try to close the door, it will probably keep on peeking out and make the door sit ajar. Every time you pass, you catch your shoulder on it. What is needed is to take the duvet out, unroll it on the floor and spend time folding it correctly and putting it well on the shelf. Now the door will shut.

This leaftlet from the Royal College of Psychiatrists explains about the symptoms of PTSD and the treatments that will help.

 

What can get in the way?

PTSD is a condition that we now know lots about. Over the past few years, lots of myths have been challenged and shown to be untrue. One example is that people who are in the frontline of battle situations are almost bound to experience PTSD. This is not true - and if you want to know more, read the work of the Academic Unit on Military Mental Health at Kings College in London. This is not meant to belittle those who have fought for their country and have suffered in doing so - it it is meant to be a warning that newspaper headlines about PTSD are not always correct. 
 

• Debriefing: another area where the newspapers are full of advice that may not be wise is around debriefing. This is the idea that we should sit people down as soon as possible after trauma and talk it through, with the idea that this makes PTSD less likely. However, it seems it actually makes it worse. Offering either a single or multiple sessions early on to everyone is not a good idea - read this overview of the research if you want to. What IS helpful is to identify suitable local counsellors who can offer their services a few weeks down the line and make sure people know that, should PTSD develop, it is not their fault and that effective help exists.

• Ignoring Injustice: the model I've described above (of fragmented memories getting stuck in the 'inbox') describes many aspects of PTSD and using CBT based on this will help with many symptoms, but not all. The most distressing symptom for some is that the trauma was not MEANT to happen. Not just that they were unlucky, but that it should not have happened to them. All of us, generally tend to work on the basis that good things should happen to good people. This is how we survive in the world. But when trauma hits us, it can shatter this assumption. You can read more about the theory, but it is important not to ignore the 'why me' question and the interpretations someone has attached to their trauma, which can result in a loss of self-worth and meaning.

• Ignoring Survivor Guilt: The opposite of 'why me' is 'why not me' - why did that person suffer in the fire and I escape unharmed? There can be extreme responses to survivor guilt, but more often it is a grumbling, nagging guilt that can be hard to shift. The key is good CBT to process the memory, but the formulation needs to incorporate this guilt too or else it will not work.

** Please note - this article is mainly about PTSD. People will experience other forms of distress and a search for meaning after a trauma. Often, these questions about meaning can emerge some months after a trauma.
 

How can the church help?

The church, along with other charities, is ideally placed to offer help in the immediate weeks after a trauma. The first response should be practical - do people have food, shelter, warmth? Let's not do any clever psychology until this is sorted!

Whilst formal psychological input should be deferred for 4-6 weeks anyway, there are some ways to 'be' with people during that time.

• DON'T assume you know what it is like, or tell people they are lucky to be alive, or minimise their experiences such as saying it was a one-off and we aren't really at war, or tell them to 'snap out of it'. People who go on to develop PTSD often don't have a background of mental ill-health, which can make them feel even more guilty or foolish for feeling as they do - don't make it any worse.
• DO watch out for changes in behaviour (being late for work, drinking more), watch for symptoms of depression and PTSD (including anger and irritability), take time to listen to their story when they are ready to tell it, and not before, and ask general questions rather than specifics.

In time, the church may be able to facilitate access to skilled psychological therapy, and this can often start with helping someone see their GP - which can be a big hurdle for many. Recent NICE Guidelines set out what the effective treatments are - avoid making assumptions. 

The other great role of the church is prayer - both for the symptoms of the survivors and also the injustice in this world.