MIND MOVESImages of traumatic events are beamed into our lives on a daily basis through the media. The havoc of war, vicious assaults, cruelty to animals, rape, torture, child abuse and natural disasters have become part of our daily diet of vicarious experience, writes Dr Tony Bates.
In spite of our revulsion, our curiosity compels us to read on, to hear more, to want to see increasingly more graphic details. We are drawn as spectators into intimate moments of violation and horror that have devastated the lives of complete strangers. For some of us, these traumas constitute news; for others, they pass for entertainment.
What impact do these images have on our lives? Do we believe that repeated exposure to trauma will inoculate us against such horrors if we, God forbid, were ever to be visited by them? Or do we draw some private consolation from knowing that they are happening to someone else. Bad news is inevitable, but isn't it comforting to read that people other than ourselves, or our loved ones, are picking up the tab?
Coupled with this morbid fascination with extreme horror there is a curious tendency to dismiss or belittle the pain of victims, which outlives the shelf life of these stories. Last year's train disaster is not so interesting to me today. And when it comes to victims of sexual assault talking about their pain, years later, we suspect they're milking their experience for sympathy or compensation, or both. Surely they can let that go, move on with their lives, get over it.
People are wonderfully resilient in the face of traumas. Many develop their own coping mechanisms that enable them to come to terms with unspeakable horrors. The courage to talk them out with friends and family help many to recover from near-death encounters that they experienced first hand or witnessed happening to others. Terror, helplessness and shock are normal reactions to extreme stresses but these reactions do subside and composure is gradually recovered.
For some, however, the trauma continues to be re-experienced long after it's over. We describe the symptoms this produces as post traumatic stress disorder (PTSD). The mind repeatedly revisits the most frightening moments of the trauma, "hotspots", as though they were happening again in the present. Fragments of memory and sensation erupt suddenly where there is some reminder that awakens them.
We call these intrusive memories "flashbacks" and while they may last only a few minutes, the distress they cause may last for hours or days. The scent of a spring day, a shape in a doorway, even a colour can re-awaken the feelings associated with the trauma. This creates the sensation of living through it again as though for the first time.
Naturally the person who is prone to such flashbacks takes every precaution to avoid any reminder that could set them off. Specific people and places are avoided, certain topics are never raised in conversation, and every effort is made to avoid thinking about the experience. Watching for anything that might cause them to relive the trauma, they live in a perpetual state of heightened physiological arousal.
To protect themselves emotionally, they may become numb and detached. This creates a distance between them and loved ones that becomes very noticeable in moments where tenderness and intimacy are normally expressed.
The shame of not being able to put the past behind them often stops people from seeking professional help. If they do, their urgent plea is for help to forget what happened. They may talk about the trauma but carefully avoid the details that were most painful for them. Therapy involves revisiting the trauma in a safe way and realising that it was not their fault.
For years people who suffered post-traumatic reactions had no language for the landscape of terror and its aftermath. The care that has been taken to map this landscape and develop specialised techniques for healing trauma has benefited many.
Most importantly, it has helped to normalise our reactions to trauma and give us permission to talk about our personal experiences rather than suppress them out of a sense of shame. Talking to each other is the best first aid we can apply in the aftermath of horror and lessens the chance of the experience becoming a disorder that chronically afflicts our mental health.
Dr Tony Bates is a principal clinical psychologist at St James's Hospital and director of the MSc course in psychotherapy at TCD.