It breaks hearts and shatters shields ? regardless if it?s caused by an earthquake, fire, flood, hurricane, abuse, a car crash, murder, or something else. Those who suffer from trauma often wonder if there?s something wrong with them.
Afrah Caraballo, a licensed clinical social worker specializing in mental and emotional trauma, wants those who suffer to know that there are logical explanations for their feelings and behaviors. She helps caregivers and victims of trauma:
? Identify the cause of the problem;
? Validate loss and begin the healing process;
? Overcome the sense of guilt and shame that hold many hostage.
You?ll also discover how to recognize the symptoms of post-traumatic stress disorder and get details on how trauma affects different age groups.
Regardless if you?re a clinical social worker, victim of trauma, or caregiver to someone who is suffering, you?ll find this guide an invaluable tool to helping yourself and others.
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Post-Traumatic Stress Derailment
A Trauma Survivor's Guide to Getting Back on Track
By Afrah Caraballo
iUniverse LLCCopyright © 2014 Afrah Caraballo MSW, LCSW
All rights reserved.
What Is Trauma?
Trauma is a violation of the heart and conscience; it breaks the heart and shatters our shield of humanity. Trauma is always about violence. Regardless of the source—natural or personal—trauma is violent. While some traumatizing events are not necessarily physically painful, they are still violent; they are a violation of one's humanity. Trauma is the violent loss of one's sense of reality or one's sense of safety. The source of trauma can be natural—an earthquake, fire, flood, hurricane, tornado, or tsunami—or the source can be person-to-person—abuse, a car crash, killing, rape, robbery, or war. Whatever the source, it is the catastrophic loss of innocence that leaves one feeling traumatized. It is the betrayal of a sacred trust or sense of safety.
The word trauma comes from the Greek word meaning "serious wound needing a physician's attention." In the past twenty or so years, it has come to mean mental and emotional wounds. Following a catastrophic event that has been interpreted by the brain and body as traumatizing, there is a breaking of trust—a violation of the relationship among the survivor, the offender, and the entire world—to include the survivor himself. At the core of every trauma there is a broken relationship, and like a broken bone, it should be repaired as soon as possible.
The state of being traumatized happens the second the feelings of terror, horror, helpless, and hopeless (THHH) collide, leaving you—however briefly—frozen in time. Trauma happens in the part of us where there are no words, the most primitive instinctual part of our physical being. Trauma is an event or series of events that leaves us speechless and in shock. I'll say more about this later; for now, know that THHH equals trauma.
Terror—intense fear; overwhelming fear on a cellular level; entire body is reprogrammed
Horror—shock; disgust; speechless; this can't be happening
Helplessness—frozen; unable to prevent this occurrence; unable to control or protect self or anyone else.
Hopelessness—unavoidable; no way out; loss of faith in self and the world (sometimes God)
If one of these is missing, good news: you're not traumatized—just freaking out.
THHH is my explanation for the "freeze" of the fight, flight, or freeze response that happens naturally whenever the body feels seriously threatened. The freeze time varies depending on the traumatizing event's effects on the body. THHH is my explanation for the space and time where trauma occurs—the emptiness left behind following the event. At some point (maybe seconds, hours, or days) after a traumatic event, you start to 'thaw out or "come to;" there's a frantic surveying of your mind, body, and environment. And the endless flood of questions starts.
-What just happened?
-Where am I?
-Was that real?
-Did anyone else see that?
-Can I move?
-Am I physically okay?
-Am I mentally okay?
-Can anyone see me?
-Can anyone hear me?
-Can anyone help me?
These questions are being asked seemingly all at once. You are trying to make sense of what happened or is happening—trying to connect and reconnect to yourself or anyone else that might be able to help you make sense of what's going on. Left unanswered, these questions can become the breeding ground for an endless list of emotional and behavioral problems and diagnoses. After a traumatic event, everything you do is about trying to answer these questions and regain the control that was lost or taken from you during the event. Your mind and body have been physiologically rewired to make sure that thing never happens again.
Trauma is about a complete loss of control over your mind, body, and environment. In that moment of Terror, Horror, Hopelessness, and Helplessness, it feels like the entire world has betrayed you. This feeling of betrayal includes the traumatized person; helpless and hopeless means there was no way to stop the terrible, horrible event from happening. If you could see a way to stop it, you wouldn't feel traumatized, and so you feel like your own body let you down and betrayed you. I say feel because that is the perception of the traumatized person or people. The most important thing to know about trauma is that it is subjective, subjective, subjective. Everyone experiences a catastrophic event differently, and it is as dangerous, scary, and traumatic as you believe it is. What is traumatizing to one person can be funny or unremarkable to another person. Popping a balloon, for example, is terrifying to a baby or a war veteran, and funny to the clueless prankster who popped it. Fires in northwestern Colorado Springs are horrifying to local residences and possibly uneventful to people in Greenland. Hear this well: trauma is subjective, subjective, subjective. It truly depends on the individuals' experiences. Judging and minimizing only serves to delay the healing process for the mentally and emotionally wounded. A group of people can experience the same exact event at the same exact time, and not everyone will be traumatized by it. Anyone can be traumatized, but not everyone will be traumatized.
The event itself isn't necessarily traumatizing. Floods, volcanoes, forest fires, or earthquakes are not traumatizing until there's a relationship with the event. Rapes, car crashes, robberies, beatings, or killings, while disturbing, are not necessarily traumatizing until you can relate. Who you are and where you are in relation to the traumatic event can determine whether or not you are traumatized—relation being the key factor. How, or if, you relate to the event or people affected by the event, has a direct effect on your response to it. Have you experienced or witnessed this event before or do you know someone who has? What you know and who you know makes a difference. Where you are in relation to the traumatic event makes a difference. For example, where were you on September 11, 2001: in the towers, in New Jersey, in California, in South America, in Europe? And who did you know: a parent, a cousin, a neighbor, a friend of a friend, a fellow American? If your house is burned down, it makes a difference how it happened. Was it a natural occurrence, lightning, forest fire, or was it a human, neighbor, friend, or relative? The answers to these questions will dictate the depth of your perceived violation. If it was natural, the violation is quite different than if you find out someone you know and cared for did this out of some sense of anger or entitlement.
You don't have to be an airman, sailor, soldier or marine to be traumatized, and just because you are in the military doesn't necessarily mean you will be traumatized. Civilians, babies, children, men, or women can experience an event that leaves them feeling like their life is in danger. A battlefield, hospital, car, alley, or home are all places where a catastrophic even can occur that leaves you feeling violated and traumatized. Relational proximity dictates your likelihood of being mentally, emotionally, physically, and relationally violated, and subsequently wounded. Natural versus human violence is less damaging than human versus human violence because of relationship. The closer the relationship, the deeper the violation—the more damaging the event and the more likely you are to be traumatized. The answers to these questions will affect your view of the world forever—innocence loss. Your sense of safety in the world or the relationship can range from completely destroyed to forever changed.
Age, gender, history, religious beliefs, or culture are other factors that can dictate whether or not you'll be traumatized. What's terrifying and horrifying to a four-year-old is not such a big deal to a teenager or an adult. What's terrifying and horrifying to an American many not be so disturbing to a member of a tribe in Africa. Childbirth or circumcision, for example, can be quite traumatizing for some and perfectly acceptable for others. Eating beef in America for most is a daily occurrence, but in India, it is a major offense for many and can be a traumatic experience for Indians who hold the cow as a sacred being. Again, trauma is subjective, subjective, subjective. Whenever you are forced out of your sense of self, your sense of safety, your sense of rightness, you are traumatized—keyword here being forced. And that violation of your sense of safety leaves a wound that must be healed.
Trauma is a surprise, a shock to the senses. The brain and body are constantly taking in and processing information—sights, sounds, tastes, smells, and sensations are constantly being recorded. This processing happens effortlessly, naturally, without any prompting. Right now your body is processing everything that is happening around you—the temperature, the smells, the objects around you, the sounds, and you're deciding what's safe or normal (based on who and where you are in the world). A traumatizing event starts out being processed much like any other event. The difference is when the brain decides something's not safe or normal. Again, without any conscious effort on your part, an alarm sounds and your body's senses are heightened. First, for fight: adrenaline and cortisol increase to reduce physical pain, pupils are dilated, heart's beating faster, blood pumping faster. Second, for flight: adrenaline and cortisol increase again to allow for the speed needed to run or escape the danger. Third, freeze: adrenaline cortisol increase yet again, this increase shuts down the hippocampus (responsible for processing and storing information and memories), the corpus callosum (helps transfer or translate allowing both sides of the brain to communicate feelings and meaning), the Broca's area (responsible for words and language), and other parts of the brain needed to process information. All the while, the amygdala (the brain's alarm system) is recording and alerting the brain and body. The brain and body's response to a perceived threat is very complex and involves the entire body in a systematic way to protect itself. Blood is redirected; ears, eyes, and skin are heightened in sensitivity; oxygen is redistributed; and digestion virtually stops. This is a simplified explanation of a complex process that happens in a matter of seconds.
THHH is an attempt to explain what the "freeze" in the fight, flight, or freeze sequence means. It's an attempt to give you a visual break down of what is happening in and to you during a traumatic event. Every aspect of the event is being surveyed and assessed: sites, sounds, smells, tastes, and touches for levels of danger. It is as if too many appliances are being plugged into a surge protector; each one is like new information to the brain, and finally one short-circuits the brain and the system overloads. That spark or pop is the trauma—the moment of THHH. For example, you're in a car waiting to turn left, and suddenly you see a car speeding toward you. You can't turn yet, and the speeding car is not in its lane (it has drifted over to your turning lane). Your brain and body are in rapid conversation assessing and processing the pending event: Can I move? Does the other driver see me? Will the driver move back to his own lane? What should I do? I can't safely turn because that truck is getting closer. Holy shit, it's gonna hit me. That mother f&%*er hit me! Pull over. Will the other driver stop? Did anyone see that? Can anyone help? Call 911. Where am I? The other driver did stop. How is he behaving? Is the driver taking responsibility, or blaming, or minimizing? Who is this person? A long series of events ensues. The entire even is scary, but not traumatizing. It is not until later, when you know what was processed and what wasn't. THHH happened when the brain and body agreed there was no way out—the freeze.
Post-traumatic stress disorder and many of its symptoms— such as nightmares, flashbacks, difficulty sleeping, difficulty remembering, difficulty concentrating, withdrawal, extreme emotional changes, and preoccupation with your surroundings (hyper vigilance)—are not the result of the entire event; they are the result of the moment when fight or flight were not possible, and the moment Terror, Horror, Helpless, and Hopeless collided (the freeze, the spark, or the pop). This is moment of perceived pending death or serious harm. At that moment, the brain stopped all major communication and went into crisis mode, which means the hippocampus and corpus callosum (the brain's information processing center) shut down, and it's up to the amygdala (the alarm system) to record what's happening while you're unconscious. Essentially, trauma is unprocessed, terrifying information that's waiting to be processed and stored as memories. And all the things we do to avoid remembering, feeling, seeing, smelling, tasting, or hearing anything that will remind us of the horrifying and terrifying event, we call PTSD, anxiety, depression, bipolar disorder, or borderline personality, and on and on the list of labels go.CHAPTER 2
What Does It Mean to Have PTSD?
Let's start with the wounded, jaded, and politically correct response, which is that everybody has some kind of trauma. While it's true that everyone has suffered a loss of some kind, not everyone has the same access to support or time to recover. While it may be true that we live in a world where violence is seemingly more acceptable, and so have been desensitized to images of violence, our internal selves are still very disturbed. Just because we can witness violence daily over dinner and nightly in our bedrooms doesn't mean we should or that the violence is okay. A violation of another is still disturbing to the body, and witnessing the violation, whether it is actual or dramatized, doesn't matter to the brain and body. The physical or psychological response is the same.
Essentially, PTSD means that at some point in your life you believed that you or someone else was in serious danger—in danger of losing life or limb—and your body responded both chemically and physically to that belief. Real or imagined, the body reacts. This is why we feel scared, angry, anxious, and paranoid after watching horror movies or crime shows, reading novels, or watching the news. Ever notice how much you eat or how alone you feel after watching? How you want to be close to someone? How you need to talk to someone? Or do you find yourself looking for the next adrenaline rush so that you never really sit with the feelings of emptiness following the loss you witness? The body's fight-or-flight response is activated every time we witness or experience a violation. Over time, we may become desensitized, but this simply means that we have been exposed to violence and loss—much like having a flu shot. We may or may not get the flu, or may or may not have a nightmare about the show or movie we watched, but it is still recorded in our memory bank, and we are still exposed. And because we are adaptable beings, we find ways to rationalize and minimize the levels of "acceptable" trauma disturbance.
To have post-traumatic stress disorder, clinically, mean that you have experienced or witnessed an event that you believed would cause death or serious harm to you or someone else. This is a rough clinical explanation. To have post-traumatic stress disorder, physiologically, means that your body and brain have experienced or witnessed a catastrophic event that was so shocking that you were THHH. It means that your body's natural defenses to danger were overwhelmed and short-circuited, and now your body's alarm system is heightened and often misfires. Post-traumatic stress disorder is the clinical name given to survivors of trauma who have not pulled it together or gotten over it in a specified period of time.
To qualify for the clinical or scientific diagnosis of PTSD, there is a specific list of symptoms and a timeline that must apply to the survivor. The primary symptoms are re-experiencing (flashbacks and nightmares) ; avoidance (physically or mentally refusing to be reminded); and hyper-vigilance (constantly surveying for danger). What is missing on this list is the hole, the loss, the sense of emptiness left after the traumatic event; it is nowhere on the list of symptoms. There is no listing for post-traumatic emptiness. Science cannot account for the spiritual and emotional void left post traumatically. Science's explanation for behaviors following a traumatic event is an endless list of diagnostic labels that include: acute stress disorder, depression, anxiety, mood disorder, reactive attachment disorder, oppositional defiant disorder, conduct disorder, bipolar disorder, borderline personality disorder, posttraumatic stress disorder, and rarely complex post-traumatic stress disorder. None of these diagnoses are sufficient, and what they all have in common is that they can only occur following a perceived catastrophic loss—a traumatic event.
Excerpted from Post-Traumatic Stress Derailment by Afrah Caraballo. Copyright © 2014 Afrah Caraballo MSW, LCSW. Excerpted by permission of iUniverse LLC.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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Table of Contents
What Is Trauma?, 1,
What Does It Mean to Have PTSD?, 9,
What Does It Look Like to Have PTSD?, 13,
Traumatized Young Children: Ages 0 to 10, 17,
Traumatized Adolescent Children: Ages 10 to 14, 19,
Traumatized Women: Ages 14 to 104, 21,
Traumatized Men: Ages 14 to 104, 23,
Understanding the Brain and Body's Need for Completion, 25,
Understanding the Invisible Wounds, 31,
What Are Depression, Anxiety, and Anger?, 33,
The Courage to Heal, 41,
Permission to Heal, 45,
Caring for the Healers, 49,