Prof. Louis Downs, PhD
Prof. Louis Downs PhD, Professor Emerituam California State University Sacramento, Counseling Department, has over 25 years of experiences counseling survivors of trauma, training disaster teams and teaching trauma therapy courses. He has published 45 papers, journal articles and books on trauma, anxiety and personality psychology in 7 nations
During a time of intense crisis there are many who attempt to give advice, console or uplift spirits. Instead, I have written this article to provide insights into the human reaction to disasters and provide information about the psychological effects of psychological trauma, so that readers can sort their own reactions and clinical and crisis professionals have a resource. This article consists of excepts from a manual I wrote for disaster mental relief, which has been published in 5 nations.
EFFECTS OF TRAUMA
When disaster strikes, individuals respond in unique but predictable ways. There are those who are resilient. Resilient does not mean that trauma has no affect on those individuals. It simply means they bounce back relatively easily. Resilient means elastic, the tendency to return to the original shape after being stretched. Resilient people offer information about their traits and circumstances that are partially or fully missing in individuals who have significant difficulty in crisis situations.
First, we know that there are some environmental factors that significantly impact resilience. These include some sort of support system. The best support systems are close bonds with another human being or better wish several. The second is having a “champion”, someone not who saves the individual from trauma but rather someone who models victory over circumstances. Alfred Adler said that all people face challenges, disabilities and weaknesses. But the mentally healthy individual learns mastery over the circumstance. A champion provides a road map of sorts by example, not by instruction. That champion might also provide a relief valve to “blow off steam.” Since another environmental factor in resilience is the ability to escape or to conceptualize escape. If an individual realizes that isolation and social distancing is simply a form of escape from contracting COVID-19 rather than seeing it as restriction, confinement, and control, it gives hope. Hope is essential to long term, healthy survival.
In relation to these environmental factors, there are some internal characteristics that are important to resilience. We’ve discussed external factors, but internal characteristics are even more important factors in resilience. For instance, the ability to trust becomes important, and the ability to be able to discern who or what can be trusted is essential to developing and keeping trust. This is important for mental health disaster relief workers and all counselors to contemplate because they are the basis of much of our relationship building skills with clients. Carl Rogers said that we are not empathetic because we think we are but rather because our client thinks we are. If they don’t then we aren’t. To be trusted we must be trustworthy. For other readers a trustworthy person is not only kind and loyal but is honest, not just consoling.
Several other internal traits have been identified in resilient people. Self-confidence, positive self-image and self-esteem are among them. Add to this ego control, the ability to express ourselves whenever it is important and to contain ourselves whenever needed. Without ego resilience, the ability to modify our direction or to adjust our personal characteristics to adapt to environmental factors, appropriate survival and thriving skills are impossible to achieve. Ego resilience sometimes requires major adjustments to life patterns or personality traits to adapt to novel, traumatic situations and requirements.
So people who are resilient are also able to put situations into perspective. They are not stuck believing only one thing in spite of evidence to the contrary. Resilient people are able to explore alternatives so that if tragedy confronts them, they can develop those escape routes we talked about earlier. The ability to solve problems, discuss and try new ways of overcoming difficulties is crucial.
People who can bounce back take care of themselves physically and psychologically. It is not an attribute that exists in withdrawal from others because part of self-care is good communication skills, the ability to ask for help and overcome imposed isolation. Resilient people can also change self-talk from self-defeating and negative ones to positive, strong and action oriented self-statements. If you think you are doomed you will quit trying, and if you think you are immune to the danger, you are doomed. If you think you can learn and grow, then you can position yourself in relation to good outcomes when the present themselves.
Being able to live in the moment rather than worrying and ruminating is important to resilience as well. So, even in the toughest of times they can find enjoyment. While working with earthquake victims in Sichuan Province, China, I heard victims of that terrible tragedy say important, resilient things. One person said that a good thing came from all the destruction; before the earthquake everyone only thought about themselves and money, but after the earthquake they thought about each other and their community. Another man said that before the earthquake he just worked, never stopped. Since then he had reminded himself of the smell of flowers he hadn’t stopped to enjoy since he was a child. And resilient individuals have the ability to appreciate what they can and can’t control. This allows them to act on the things they can succeed with and accepts what is beyond their control.
Responses to trauma that keep a victim from being able to become resilient fall into three categories. These categories are called avoidant patterns, overactivation and underactivation. Avoidant individuals develop symptoms that keep them from recognizing and dealing with issues that have developed from the traumatic circumstance. Overactivation means that the individual is overreacting, showing high level of emotional response. Underactivation is exactly the opposite: the individual reacts as if nothing had happened at all or by finding ways of discounting or forgetting the event itself and so its impact.
When discussing avoidant responses we have to be careful to do is not to judge the intentions of the victim who responds in this way. It is neither a conscious choice nor a moral breakdown. It is usually related to what we talked about with the inability to ego adjust. If a person cannot either express or contain him or herself in a high stress situation nor adjust personal characteristics to fit the environment then there is a tendency on some peoples’ part to internally protect themselves, unconsciously. And unconsciousness is automatically out of control of the individual until they become aware of the reaction so as to take control again.
Avoidant responses range widely. One method of avoiding pain is called dissociation. Dissociative states are a way of forgetting what occurred, either by shutdown of memory, consciousness, or self-identity. Think of this as someone who cannot remember anything about what happened in the tragedy. Their memory from just before the tragedy until much later was simply scrubbed clean.
Another form is psychophysical responses, also called somatoform responses. The person become in some way physically handicapped, whether that is becoming ill or having physical rather than emotion pain or developing other physical symptoms that have no basis in bodily function, like blindness or paralysis. Substance abuse is a form of avoidance – numbing pain. Again, working with Chinese victims of the May 8, 2008 earthquake, one man, when asked what was different in his life since the catastrophe said simply, “I have learned how to drink.” Finally, the rare individual becomes psychotic, losing touch with reality even to the point of hallucination and delusion.
Some people wander through the suffering of others aimlessly, stare off into space, or seem to be handling things with incredible ease but without the ability or willingness to talk about what is occurring. This is a harder state of being to discern because resilient people may also “take things in stride”. However, the ability to be resilient includes not only the ability to take care of self but to seek help and not to try to do it all alone. So “taking things in stride” may simply be internalizing, which is dangerous.
When we look at stress responses that occur months after a disaster, including Post Traumatic Stress Disorder and psychosomatic disorders we almost invariably discover that the individual who develops the disorders has internalized stress rather than found safety valves for releasing the stress. The immune system has been shown consistently in studies to be directly affected by unrelenting or unresolved stress.
Some individuals in crisis situations respond with panic, symptoms of high anxiety, judging or blaming others, seemingly irreconcilable crying or anger and other acute stress responses. It is a healthy and normal thing for a victim of tragedy to activate to the point that he or she is motivated to respond, for survival instincts to kick in, or to resolve difficulties occurring in the aftermath of a disaster suitably. But overreaction will freeze a person’s will to act in a rational fashion as the chemicals produced in the amygdala, the emotional center of the brain, overcomes the ability to produce neurochemicals that allow full thinking ability and may also worsen a situation by either hampering disaster relief worker efforts or spread panic among other victims.
Overactivated responses usually occur in one of two ways, either as an immediate response to a disaster as it occurs, or as intrusive memories of the event invade the survivor’s consciousness. Either way the reaction is likely to look the same.
Psychiatric or Abnormal Conditions of the Mind Responses
A rarely occurring reaction to disaster is a loss of orientation to reality, with a lack of ability to function or to respond to reality. Luckily these are rare occurrences, but often enough to be considered. Psychiatric responses fall into two categories, depressive or psychotic responses (loss of orientation to reality, with delusional or hallucinatory effects).
Because the victim of this type of response is incapable of regaining control without major psychiatric intervention, it is important to be able to recognize the states so as not to waste time attempting to talk a person down from the state; the importance is getting the individual help as quickly as possible.
It is my hope that this information will help some recognize their own responses so that they can become more resilient or to aid recognition of unhealthy or inadequate reactions in others in their own communities. We are all in this one together.
Downs, Louis L., (2017), The Disaster Relief Mental Health Training Manual, 3rd Edition. Singapore MINDEF.
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