AFTERMATH OF TRAUMA: HOW TO REMAIN HEALTHY
by Dr. Abbas Azadian, MD & Jean Hackney
Over the past few months I have been frequently asked about the psychological consequences of the terror in the
People wonder what kind of psychological reactions they should expect. They wonder how long the effects are going to last and how severe they are going to be. To provide an honest answer I have to say that we do not know. In
One man who escaped the tragedy said: "I am traumatized for life!" He may not have a degree in psychology or may not be a psychiatrist but he is right in his cynical anticipation. People who observed the trauma first hand and those who escaped it narrowly may be traumatized for life. Who can forget those horrifying scenes?
One woman was in a business meeting on the 70th floor when the first plane crashed. "We could not see the plane coming toward us but we saw fire, smoke and papers", she said. She made it to the 44th floor when the second plane hit the opposite side of the building. "The building swayed probably about two feet. I thought at that point it was going to topple over. That was the moment I was probably the most scared."
She may remain scared for the rest of her life when she is walking up or down any stairwells. These people not only observed the most terrible scenes possible, they narrowly escaped certain death as well. The closeness to trauma and the magnitude of what they observed will put them at major risk of a psychiatric disorder.
People are different and have different characters and backgrounds. They react to events differently. In general, the immediate behavioral reactions may include anxiety, depression, irritability, numbness and detachment. These people may feel that they are walking in a void. They may not be able to connect to others. There may be a sense of loss of time and space as though they are walking in space and daydreaming. They may be confused and not able to recognize where they are and who they are.
This confusion may lead to a more distressing phenomenon. Being confused about time and place, the victims may think that the events are happening again. They re-experience the events as though they are occurring. For the victim this experience is as real as the original event. During these times they may react with horror. Their heart may start racing and they may have difficulties breathing. They could become nervous and develop muscle tension. They may scream and try to run away. They will be detached from their environment.
These behavioral and physiological responses will not be limited to when they are awake. They may have difficulty falling asleep. They review the events again and again. Eventually when they sleep they re-experience the events in their dreams. They wake up from nightmares screaming and drenched in sweat. They may be confused or look frightened. They do not know where they are. Their heart starts racing again. They may not be able to go back to sleep for the rest of the night. This is going to affect their ability to concentrate and think. Their memory will be slow. They feel tired and cannot function or relate to others easily.
Victims of a tragedy as horrifying as this are going to react to these terrible events emotionally as well. The feeling of terror will continue. They feel unsafe. This includes a sense of being unable to protect themselves. The experience leaves a deep sense of distrust in them and they may not be able to rely on others when they need to. They cannot trust others. They feel helpless and think that their actions cannot change or influence current situations. They feel numb, empty and used up. They may have a dull sense of terror, horror, and rage about what happened and may not be able to express these feelings. These events will change the way they look at themselves, the world and others.
These reactions will not be limited to people who observed the tragedies first hand or were within the vicinity of the events and so at risk. They may happen in people who have been repeatedly watching these events on television. The risk is lower, the severity of reaction less and the length of reaction is shorter. Nevertheless the risk exists and we all have to be watchful and try to protect ourselves.
People react to stress in different ways; however, there are common behaviors that teachers might see in the classroom as a result of such a tragedy.
There may be disruptions that learners experience around the tragedy, and this may mean that:
• Some learners may not be prepared to learn. They may be apathetic, being uninterested in learning. Their emotional distress may get in the way of academic progress
• Some learners might be unusually quiet or withdrawn
• There might be increased absenteeism (complaints of headaches, stomachaches, or other symptoms of illness)
• There might be outbursts of anger, irritability or sudden changes in mood
• Learners might appear more distracted than usual; have poor concentrations, attention problems, restlessness, or daydreaming
• Some learners might be lethargic, tired and perhaps sleep in class
• Classroom management may be more difficult; teachers may have to deal with regressive, withdrawn or disruptive behavior.
You might not be aware of the effects of long-term disruptions immediately. Problems might not surface until weeks, months, or even longer after the disaster. As teachers, there are things you can do in the classroom around the tragedies of the past few months. Provide classroom activities that will help to learn how to cope with difficulties:
• Provide activities that encourage learners to share experiences and express feelings
• Introduce a study unit that focuses on learning about disasters
• Prepare a study project on health and safety to give students a feeling of competence, confidence and control in being able to handle disaster tragedies
Teachers may face greater strains if they are having disaster related difficulties of their own. Take care of yourself. You might find that the classroom activities create stresses for you as well. You will be a greater help to students and your colleagues if you can acknowledge your own experiences and feelings.
Teachers are continual learners. Some general knowledge around trauma can be helpful to yourself and the learners. Trauma can be isolating and people may feel separated from one another. To avoid this, try to share your feelings and thoughts with others. Seek support from friends, family and co-workers on the one hand and help them to deal with this tragedy on the other. Allow yourself to cry; it provides a good relief and release. Write, draw or use any other medium to record your thoughts and emotions. Spend more time with your loved ones. Plan some outdoor activities. Go for a walk. Listen to music. Do exercises. You do not have to follow the news channels all day long. Give yourself a break.
In particular, be mindful of children. Make yourself available to them so that they know they could talk to you. There is nothing wrong with showing emotions, like crying, in front of children. It tells them that you are a normal human being who cares for the well being of others and feel hurt when others are hurt. But remember not to show excessive distress and anxiety in front of them. Remind them that despite isolated events like this, no matter how horrible the event, they are still living in a relatively safe place in this country. And remember that disasters may also provide an opportunity to change and grow and become stronger. Tragedies may bring us closer to each other. The last thing to remember is that if you did all of these and you still experience difficulties, then you should talk to professionals. In particular, talk to your family doctor.
Many people who experience tragedy so closely could be affected for the rest of their life. They are going to love but not the way they used to. They are going to live but not how they used to. They are going to work but not the way they used to. They have changed for life. They may even become stronger.
