What is trauma?

Trauma is a psychological wound that results from an emotionally-demanding circumstance or incident. Trauma results from the inability of the person to cope adequately with what they have experienced and/or witnessed. Therefore, a circumstance experienced as traumatic for one person may not be experienced as traumatic by another. For example, a student witnessing the death of a cyclist might be traumatised by what she saw, whereas a paramedic, on the scene at several deaths each week, may not be traumatised by witnessing a similar event. A racing driver might be used to experiencing quite violent car crashes, whereas a social worker might be traumatised by the experience of an urban road traffic accident. A key feature of whether an event or circumstance is likely to be experienced as traumatic is whether it is perceived by the person as a threat to their physical or psychological integrity.

People involved in overwhelming disasters and incidents often report typical reactions. Knowing about these reactions can be useful, because it can help us see that we aren't going crazy or that we aren't weak and inadequate. Such experience is a normal reaction to an abnormal event. Also, it's important to realise that each person deals with trauma in a slightly different way, because each situation is unique.

• You may experience episodes of repeated reliving of some aspects of the trauma in the form of intense memories (called flashbacks), nightmares and frightening thoughts. You may also experience physical reactions to situations that remind you of the traumatic event. This repeated reliving of the traumatic event could disturb your day-to-day activities and functioning, and result in a lack of interest in normal activities.
• At other times you may experience a sense of numbness, emotional blunting, perhaps even a feeling that you don't care about anything. You may feel detached from other people and then frustrated that they don't seem to understand how you feel.
• You are likely to experience a wide range of different emotions, such as fear, anger, sadness, guilt, etc. In the immediate aftermath you may feel vulnerable, the world might seem threatening, and the future uncertain. Therefore fear and panic are very understandable emotional responses. Anger is another common response. You may feel angry because of what has happened to you, angry because you don't feel in control of your life any more, angry with others for making you suffer either deliberately or unwittingly. Some people may start blaming themselves for what happened and feel guilty about the event. Some may experience survivor guilt (guilt over surviving while others did not), although they aren't responsible for it in any way.
• The experience could trigger physical symptoms such as palpitations, patchy sleep, poor concentration, agitation, dizziness, etc.
• Traumatic events or incidents could rekindle feelings of previous trauma and loss, which has perhaps been buried or denied for many years.
• Trauma may lead to a reassessment of your vulnerability and the meaning of life, because it can overturn so much that was previously held dear.

It is important to realise that all of the above and perhaps other reactions as well, are understandable and normal responses to an abnormal and overwhelming event.

Recovery takes time. A psychological wound cannot be forced to heal quickly. It is no different from a physical wound. Flowing with the healing process is better than fighting it. This process can be described as moving from victim to survivor. There are some common elements in this period of healing:

• You acquire more control in remembering the event. Memory and emotions are joined. The memory is re-examined and then filed away.
• The trauma may still affect you, but it is no longer overwhelming.
• The troublesome symptoms recede, become more tolerable and predictable and gradually fade away.
• You are able to reconnect with others and move on with your life.
• You are able to give some new meaning to both the trauma and yourself as a trauma survivor.
• For some it can lead to a re-appraisal of their basic priorities and values, which may result in important positive life changes.
• Still others are able to transform their experience, through adversity and suffering, into a gift enabling them to help others in similar circumstances.

Helping others

You may want to be supportive to a friend who has suffered a traumatic incident but be unsure about how to go about it. The most important thing you can do is offer to 'be' there with them. Immediately after a trauma, people are likely to be in shock and may not be able to talk about the incident or their feelings. Be gentle. Comfort them in non-verbal ways - warm sweet drinks are good, holding hands or touch if appropriate - letting them know its OK to cry or rage or be silent if they need to. You don't have to 'do' anything other than be present or to listen if they want to talk. Do not attempt to 'debrief' them with endless questions, as there is some evidence that this can reinforce the trauma and make it harder to deal with later.

Be specific about the amount of time you have (e.g. I want to spend the next hour with you, but then I need to go and write an essay/go to the Library/phone my parents, etc.). This allows your friend to relax, knowing its OK to share for that hour and that they are not 'burdening' you (an understandable worry between friends). Sometimes, it may be quite harrowing to hear what they have to say. If so, it might be helpful for your friend to see a counsellor, GP or chaplain. You can still continue to show support in other ways: e.g. going along with them to make an appointment, meeting them for coffee, cooking their supper, continuing to socialise, etc.

What is likely to help:

• being available - being present when they desire your presence, and willing to leave when they wish to be alone
• inviting them to talk - they will not know whether you are ready to listen unless you tell them
• listening when they wish to talk
• respecting their decision when they feel unwilling to talk
• supporting them in practical ways, such as cooking, cleaning, shopping
• supporting them with gentle encourage to be patient - trauma takes time to heal
• encouraging other people to be patient with them
• encouraging them to seek professional help, such as counselling.

What is likely to hinder:

• trying to stifle their expression of emotion
• trying to suppress their negative feelings
• trying to cheer them up
• making jokes about the event/circumstance
• changing the subject when they wish to talk
• telling them that someone else is worse off
• telling them to "get a grip"
• pretending that nothing has happened
• asking questions about the event - to a person who is traumatised, this can instantly feel like interrogation.

If you are worried that your friend needs help from someone else but they are reluctant to go along with this idea, you can contact University's Counselling for advice. We will do our best to support you.

Acknowledgments
This is based on two leaflets entitled Trauma by Zinaida Lewczuk 
and After a Crisis by Jenny Bell, Loughborough University
© 2005, The Counselling Service, University of Dundee