Everyone experiences stress in life. But some events are so stressful they overwhelm our ability to cope, to even function at all.
A disaster like the terrorist attacks on New York's World Trade Center and the Pentagon is an overwhelming stress. That it was a possibility no one imagined and our minds even now strain to comprehend only compounds the psychic shock. Whatever cognitive framework we have for understanding the world collapsed, destroyed, along with those towering buildings, so many thousands of lives, jobs, and families, by those planes-become-guided-missiles.
Events can inflict trauma on participants and even witnesses to the degree that the events are severe, sudden, and inescapable and carry the actual or implicit threat of death or personal injury. They shatter our belief that the world is a safe place. We feel powerless and insecure, afraid of what might happen if we let our guard down. The sense of powerlessness and helplessness spills over and makes us feel that life is beyond our control. Even the simplest of decisions can become impossible.
Many people were directly affected by the disaster. They had to run from the World Trade Center after the towers were hit and as the structures were collapsing. Anyone who saw the videotape of the second plane crashing into the south tower was witness to a mass murder. We watch it over and over, unable to process the information; it is too large.
Those who lost loved ones endured further trauma. And rescue workers are exposed to scenes of devastation constantly. What magnifies the impact of this disaster for every American is the growing belief that it may not be a solitary event but one of a series of crises yet to be inflicted on us, that it is merely the opening salvo of a new kind of war. We are all frightened by the implications of the attack.
For a time, we walk around in shock. We feel emotionally numb, testimony to the power of the event to overtake our coping mechanisms. Gradually, if we let it, feeling returns. And as it does, so does the opportunity to heal.
Healing requires that we accept the feelings we have and understand them as normal responses to unusual events. We also must assimilate the experience and integrate it into a new, expanded worldview that allows us to function again while prudently safeguarding ourselves.
For many, the return of feeling marks a descent into depression. The events are overwhelmingly sad. Loss is a major trigger for depression and there is much to grieve for, including our own lost innocence.
But we can also emerge sane and strong. Trauma experts know that post-traumatic stress disorder is possible and common in the wake of a disaster of this magnitude. But it is by no means inevitable.
Every disaster is unique. It is their very nature that we have experienced nothing like it before. Yet in some ways they are all alike. They impact us in ways now known to be predictable. Over the past decade, experts have made great strides in understanding our response to traumatic events.
According to Rachel Yehuda, M.D., head of the Posttraumatic Stress Disorder Program at the Bronx (New York) Veterans Administration Medical Center and professor of psychiatry at Mount Sinai School of Medicine, "PTSD represents a type of a response to trauma, but not the only type. It is a response that seems to be about the failure to consolidate a memory in such a way as to be able to be recalled without distress."
For reasons not yet clear, the traumatic event can prematurely shut down the body's stress-hormone response. The brain then floods with neurotransmitters that perturb memory consolidation so that there is distress associated with the memory.
There follows a period of incubation when more distress can compound the process, turning it malignant. Or people can take active steps to remove the distress around the troubling memory.
People vary enormously in their capacity to respond to traumatic events. Many factors influence the response to stress (see below).
Trauma experts know that three things are critically important in diminishing the distress.
- Perhaps the most import action people can take is to talk about the trauma, to express the pain they feel. The struggle to put feelings and images of horror into words tames the indescribable.
Not everybody wants to talk about the trauma, however, because it is very disturbing, and experts believe that no one should be forced to. But those exposed should be educated about the need to do so, that talking about the experience will make the memory less distressing.
And they should be skillfully led into processing emotions surrounding the trauma despite the difficulties and despite the desire to avoid them. If the horrific is not processed, it will eventually be expressed, in intrusive thoughts or in nightmares, or in physical symptoms; whatever physical vulnerability a person carries will be the site that breaks down.
For some who have been at Ground Zero of the disaster and must continue to be so, such as firefighters, the numbness is highly functional and allows them to finish their work. Even so, there is a time when the talking must begin.
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