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Palo Alto Online

Publication Date: Wednesday, September 19, 2001

Guest Opinion: Experiencing trauma even remotely may leave internal scars Guest Opinion: Experiencing trauma even remotely may leave internal scars (September 19, 2001)

by Deborah Rose, M.D.

The assault on the World Trade Center and the Pentagon last week will leave their psychological impact on all of us for a long time, and for some of us, permanently.

How have they done this? What can we do to lessen or even prevent the damage?

The answer to both of these questions lies in the understanding of the nature of psychological trauma.

We have all had at least a brush with psychological trauma, whether it's a near-miss collision on the freeway, rubbernecking while driving by an accident, having an acquaintance die unexpectedly, perhaps as we witness it, or hearing of an assault on an acquaintance.

The vast majority of us will have an absolutely typical, "normal" response to such events. We usually recover rapidly and completely. Once again, our normal responses to trauma recede out of conscious awareness. But the more severe the traumatic experience is, the more likely that these normal responses will remain inside of us and perhaps even become damaging.

How does the typical and expectable response become harmful? The key to this lies in the fundamental nature of the traumatic event -- that is, an event that is outside the normal expectable human experience, resulting in death or serious physical harm to someone important to oneself. The experience can be witnessing the traumatic event, or just hearing about an important person in one's life to whom trauma has occurred.

Because the event is outside the normal, we are not prepared for it psychologically. We do not have available within us the preparation that allows us to understand what we are feeling and thinking and to have a repertoire of mechanisms to help us get through it. Having advance mechanisms is the result of being helped by others from early in our lives onward to learn and find words for our psychological functioning and ways to comfort and help ourselves.

Lacking such mechanisms results in an inner state of terrifying, traumatic helplessness. We have no words because we have never been prepared for the event.

When in an inner state of traumatic helplessness, we feel terrified. Not only is our internal psychological world shattered but also our ongoing physical health is endangered by our body's responses to severe stress. Our very lives are at stake -- because trauma can kill.

We may also feel terrified that we are out of control or, even worse, "going crazy" because we can't understand ourselves any longer. Because we have no words for our inner experience, we cannot communicate about it, to ourselves or to others. This results in a profound sense of aloneness and isolation and the belief that no one can understand what we are feeling.

Because we have to protect ourselves somehow from this psychological and physical "life threat," all of us begin to put a series of defenses into action. The most prominent ones are psychological numbing and deadening, assigning blame,and expressing what one is feeling inside by putting it into action.

All of the defenses serve to try to put the traumatic reactions outside of oneself, onto others and the world at large. Other people and the world then become the frightening things, the problems.

Psychological deadening can be heard when people say they are speechless, dumbstruck, in shock, and in people reporting they feel numbed and deadened. They may give the impression of being calm and unscathed. Being numbed protects us from being disabled acutely by the trauma so that we can protect and save ourselves. But if it persists it can become a permanent state of being, a "living death."

Assigning blame whether it is of oneself or others is a way we try to create the illusion for ourselves of not being helpless but in control. We may find fault in the past actions of ourselves or others and believe these actions to be the cause of the event. Or we may plan for how we will act in the future so that trauma will never befall us again.

This shifts the focus from the fact that the trauma has already happened and that helplessness is indeed our internal state. The blame of oneself and others, if it persists or is overwhelming, leads to rejecting and attacking ourselves, resulting in depression and living in fear of attack from others.

Because we are not prepared with words for the traumatic internal experience, we have to use action and bodily sensations to communicate. Using action to communicate commonly causes arguments, acts of delinquencyand attacks on others. It may also lead to suicide. Bodily communications lead to increased experiences of feeling -- and being -- ill.

For anyone with persistent symptoms of a traumatic experience, help is available -- and the prognosis is excellent.

But the sufferer may find it terrifying to think about getting help, for the very reasons noted earlier: because the sufferer feels to blame, is terrified and fears being confirmed as crazy by the therapist.

Any therapist skilled in treating psychological trauma -- officially Post-Traumatic Stress Disorder -- can help with.such fear. With treatment, the sufferer can expect full relief and may even do better than before the trauma. Dr. Deborah Rose is a psychiatrist in private practice in Palo Alto She serves on the clinical faculty of the Department of Psychiatry at Stanford University, and has been a consultant to the Mid-Peninsula Rape Crisis Center and the National Center for Post-Traumatic Stress Disorder at the Palo Alto Veterans Administration Medical Center.


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