Tour of Duty

Inside the mind of a vet

What Is Trauma?

Trauma is not just the events themselves, but how we deal with them

When I have presented and discussed cases to colleagues of combat trauma over the past few years, I have often seen reactions that bothered me. Seasoned therapists have found my patients “hard to empathize with.” I was even advised before a major presentation last year to remove the frequent references to loss of life that were in descriptions of combat scenes. I was advised it might bring up “too negative of reactions” for listeners. Frankly, I had not expected or accepted negative reactions. I have ample exposure in the military to the madness of combat. Don’t people know this is happening every day? They don’t know this is the world we live in? I realized not. I chose, instead of removing the references to killing, to emphasize them so people would feel the pain of my patients and the shattering experience of combat a little more. I felt like I understood and could bear better than them. But I soon found myself face to face with a patient’s experience that was unbearable to me.

Following that presentation, I began treating a Soldier with severe post-traumatic stress disorder (PTSD). I encouraged him to share his experiences with me, and helped him feel that maybe I could understand them. I soon found myself hearing a level of violence I had never encountered before. I didn’t want to hear what he had experienced. I found myself disgusted that he could have lived such a life, and that he felt nothing about the experiences at the time. He described how he enjoyed combat, how he missed it. I couldn’t go there with him. I couldn’t hear the graphic details. I could feel his never-ending accounts of killing after killing shattering what was left of my sense of a just, sane world. I couldn’t bear hearing anything in those moments. I could not understand such madness. I froze and became numb. I disappeared from our dialogue. He continued on without me for several more moments. I looked for an escape, and luckily for me, I realized our session time was coming to an end. I spent the rest of that day after he left feeling numb and uneasy. My ability to listen and tolerate horrific experiences had been surpassed. I found myself, humbly, in the same position as my colleagues: human and also unable to bear the traumatic experiences of combat. But I also realized that I had left my patient alone in his hell of guilt and shame. At least I hope I had not outwardly rejected his actions. I dreaded his return to my office in a few days. How could I tolerate sharing with him such experiences, and how could I tolerate the changes I feared it would bring in me? I envisioned myself becoming more traumatized as I attempted to provide him a relational home to process such feelings during our future appointments. But could I?

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This account of my experience of a therapy session with a Soldier suffering from combat-related PTSD is a starting point for discussion about trauma and treating its effects. What makes events traumatic? How can we understand the role of people around us in helping us bear the effects of trauma? Why did I “numb out” while listening to this account from my patient and how does this affect his own emotions? How do the events one person has experienced affect someone else who wasn’t even there?

As I will explain more in future blogs, trauma is not just the events themselves, but how we deal with them. Terrible events in our lives bring up difficult emotions. As social beings, we naturally try to process these feelings with other people. When others either cannot listen to our experiences, whether they are our peers, family, or even our therapists, we feel we cannot share our emotions with others. Then we try to deal with the difficult emotions by pushing them out of our awareness. In the session I described above, this Soldier was only just starting to tolerate feelings being back in his awareness that he had not shared with anyone. We continued to process his feelings about his combat experience over the coming months. Immediately after a traumatic event, pushing emotions away without processing them can eventually weigh us down and overwhelm our ability to cope with the world. Our experience of ourselves and our world can then become shattered and traumatized.

Russell Carr, M.D., is a naval psychiatrist who heads up adult outpatient psychiatry at the Walter Reed National Military Medical Center in Bethesda, Maryland.

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