The concepts of “stress” and “trauma” are broadly understood by almost everyone in modern society. In fact, we often use the words “stressed” and “traumatic” to describe our reactions to everyday events. Generally, with “stress” and “trauma,” what we are talking about are difficult, sometimes devastating situations that occur in the course of living. Life is multifaceted and often harsh. All of us encounter challenges that become pivotal in defining our lives. Over the course of a lifetime, not all of us will experience serious illness, marital break-up, victimization, abuse, or financial reverses—although likely we will know someone who has. Unfortunately, these situations are not rare. In contrast, there are stressors, sometimes called “catastrophic,” that are outside the realm of usual human experience. Usually these involve dramatic violence, death or its threat, or the possibility of severe bodily harm.
As we have become more psychologically knowledgeable, it has become evident that there is more or less a typical reaction that occurs in reaction to “catastrophic” stress or trauma. There is a group of psychological symptoms, some of which are strange and dramatic, that seem to be experienced by people of all backgrounds, ages, and gender when “catastrophic” stress occurs. This is called Post-Traumatic Stress Disorder or PTSD. Not everyone experiences all symptoms. Each individual's reaction is unique in terms of how serious and disabling the symptoms are. Some reactions may be immediate; others delayed. Some people do not react at all or only briefly.
When people do react, it is often frightening. Since typically “catastrophic” stress involves what appear to be random events, the victims are often normal, ordinary people simply going about their lives. In the space of an instant, they are confronted with the possibility of death or severe harm. In the aftermath, they may begin to feel they are losing control and possibly their minds.
The person may experience intrusive thoughts and images that seem to relive the trauma (and all the fright that went with it). There may be paranoia and a tendency to startle easily. Emotional numbing and withdrawal from loved ones, irritability, anxiety, sleep problems, nightmares, and loss of sexual interest and appetite may occur. The person may have obsessive thoughts and fears and experience panicky avoidance of people and places associated with the trauma. All of this is clearly beyond the individual's psychological control.
Yet this reaction makes sense if we remember that in the midst of “catastrophic” stress, the overall reaction is fear—not worry, not anxiety, but “in the gut” animal instinct fear. In a split second, we become the animal within and have the same “in the blood” “fight or flight” mechanism that we see when the hair goes up on a cat—a dog or tiger stands ready to spring—or a snake coils in anticipation.
Human beings also seem to condition quickly if the stimulus is intense enough. This is both biological and psychological. A bad case of food poisoning and we may never eat that food again and may even become nauseous every time we smell it. When exposed to “catastrophic” stress, in an instant, this intense animal fear reaction becomes associated with the trauma involved and sometimes to the world at large.
Once the threat or stimulus is no longer present, our entire sense of bodily and psychological integrity is disrupted—in other words, we have been injured. Our usual sense of being—which integrates physical sensations, emotional responses, perceptions, and thoughts—is thrown off-kilter, out-of-whack. That is why the symptoms in PTSD appear so dramatic and frightening. We can heal, often completely, but it takes time and sometimes treatment.
The longstanding effects of “catastrophic” stress are often minimal or nil. This does not mean that the person gets over the trauma once and for all (and symptoms may be evoked by anniversaries or stories or events similar to the trauma throughout one’s life). What it does mean is that the trauma no longer affects day-to-day functioning, interpersonal relationships, or one’s subjective sense of well-being. Ultimately, this depends on the person and the nature of the stressor.
The reaction may also be complicated by certain factors. There is going to be a more severe reaction if one’s life was actually threatened, as opposed to being a witness, although even second-hand exposure to violent events is traumatic. If people actually died during the catastrophe, particularly loved ones or close friends—if the “catastrophic” stressor is severe or prolonged, such as repeated exposure to combat or wartime brutality—or, if the victim was not simply threatened with death or harm, but actually was physically harmed (for example, being raped or shot and left to die)—the response is complicated, so recovery and adjustment may take longer.
The good news is that these “catastrophic” trauma reactions are very amenable to treatment. Therapy, counseling, support groups—if the individual has the opportunity to participate and is willing to take advantage of this—are very successful in treating the effects of “catastrophic” stress. For many, with time and healing, the trauma can once again become an event outside usual experience.
Dr. Judy Marshall received her doctorate in clinical psychology from the University of North Carolina at Chapel Hill. In thirty years of clinical practice in New York and Los Angeles, she has worked with many different groups, from children to the frail elderly, with particular interests including self-esteem, depression, sensitivity, and creativity.
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