Post-traumatic stress disorder -- aka PTSD or simply "trauma" -- is a growing problem, with adults and children today affected by threats of terror; combat in the Middle East; and social, economic, and personal crises. It is a hidden disease affecting ten percent of the population -- many whether they know it or not. This book explains how PTSD arises, how to recognize its effects, and how to stabilize and recover from it, focusing on three areas: how to cope, how to help children and other loved ones, and how to recover happiness. Based on 18 years of field experience and practice, the author provides specific suggestions for handling trauma reactions like anger, anxiety, and withdrawal; discusses how to work through long-term effects; and includes numerous case examples and guidelines for self-help. Accessible and timely, his book speaks to healthcare professionals, military families, and anyone seeking coping strategies in the current world climate.

After the Storm

Healing after Trauma, Tragedy and TerrorBy Kendall Johnson

Hunter House Inc., Publishers

Copyright © 2006 Kendall Johnson, Ph.D.
All right reserved.
ISBN: 978-0-89793-474-9

Contents

Acknowledgments...........................................................................................42A Note from the Author....................................................................................43Introduction..............................................................................................44Times of Uncertainty......................................................................................45Living in the New Age of Anxiety..........................................................................45Personal Crisis Against the Backdrop of Fear..............................................................47How to Use This Book......................................................................................48Part I: Global Uncertainty and the New Age of AnxietyChapter 1: Living in Troubled Times.......................................................................52Sources of Uncertainty....................................................................................52Living in Fear: The Effects upon Our Health...............................................................53Is It Stress or Trauma?...................................................................................54Contemporary Angst and Personal Crisis....................................................................57Chapter 2: Your Personal Response to Tragedy, Terror, and Uncertainty.....................................58Nothing Occurs in a Vacuum................................................................................59Your Personal Sense of Well-Being.........................................................................59Getting Down to Specifics.................................................................................60Attitudes and Beliefs.....................................................................................68Things to Think and Write About...........................................................................68Chapter 3: How Our Body and Brain React when We're Threatened.............................................69Some Helpful Terms........................................................................................70How We Respond to Crisis..................................................................................70Stress Triggers a Chemical Cascade Inside Us..............................................................71When Things Fall Apart: Acute Stress......................................................................73Chronic Fear and Anxiety Can Create Episodes of Acute Stress..............................................76Things to Think and Write About...........................................................................77Chapter 4: Seeing the World Differently after Crisis and Trauma...........................................78Building a Worldview......................................................................................78The Outer "World" as an Internal Construction.............................................................79Crisis, Memory, and Survival..............................................................................80Flashbulbs in the Dark....................................................................................83Cerebral "Indigestion" and Hidden Memories................................................................84What It All Means.........................................................................................85Things to Think and Write About...........................................................................86Chapter 5: Is It Trauma? Delayed Stress Reactions.........................................................87The Past Catches Up.......................................................................................88Delayed Reactions to the Storms of Living.................................................................91Posttraumatic Stress Disorder: What It Is and Is Not......................................................92Things to Think and Write About...........................................................................98Chapter 6: Serious Complications: Understanding Complex Trauma............................................99Layers of Trauma from Events Past and Present.............................................................99Peeling the Onion: Childhood Trauma, Sexual Abuse, and Combat.............................................102Memory Revisited..........................................................................................102Troubled Times and Low-Level Traumatic Stress.............................................................106Things to Think and Write About...........................................................................107Chapter 7: Running Scared in the Brave New World: The Wounding of Spirit and Attitude.....................108Chronic Trauma, Collective Angst..........................................................................108Toxic Conditions, Toxic Beliefs...........................................................................110Running Scared............................................................................................110Joys of the Heart and Spirit..............................................................................111Assessing Spiritual Balance...............................................................................114Things to Think and Write About...........................................................................116Part II: Tools for Hope and HealingChapter 8: Keeping It Together when You're Falling Apart..................................................118Losing It.................................................................................................122The Range of Our Response to Crisis.......................................................................124What to Do: Tools for Managing ASR........................................................................129Things to Think and Write About...........................................................................135Chapter 9: Letting Go of Fear, Anger, and Loss............................................................136A Quick Review of the What and Why of Arousal.............................................................136Going to Extremes.........................................................................................137The Basics of Managing ASR................................................................................138What Can We Do?...........................................................................................138Countermeasures for Episodes of Emotional Overreaction....................................................139Special Case: When Resentment Keeps Exploding into Rage...................................................141Special Case: When Fear Boxes Us In.......................................................................145Special Case: When Sadness Becomes Acute..................................................................148Opening to Peace..........................................................................................151Things to Think and Write About...........................................................................152Chapter 10: Dealing with Withdrawal, Numbing, and Depression..............................................153Calling in Air Strikes on Our Own Position................................................................154Brain Fade................................................................................................154Where Has Life Gone?......................................................................................156What Can We Do?...........................................................................................157Countermeasures for Episodes of Emotional Shutdown........................................................157Serious Forms of Dissociation and Depression..............................................................158Surfacing: The Larger Journey Back........................................................................162Hidden Agendas: Uncovering Our Attachments to the Past....................................................163Finding New Meaning in Old Distress.......................................................................166Opening to Joy............................................................................................167Things to Think and Write About...........................................................................168Chapter 11: Stabilizing Our Children and Families.........................................................169Parenting During Difficult Times..........................................................................169Talking to Children after a Crisis: An Example............................................................170Stabilizing Teens.........................................................................................177Strategies for Coparenting................................................................................179Austere Triage for Family Arguments.......................................................................180First Aid for Family Chaos................................................................................181Things to Think and Write About...........................................................................183Chapter 12: Getting Professional Help.....................................................................184Frequently Asked Questions about Therapy..................................................................185From My Side of the Room..................................................................................187Issues and Resolution.....................................................................................189Different Ways to Go......................................................................................192Shop Around...............................................................................................195A Few Words about Medication..............................................................................196Choosing for Fit..........................................................................................196Things to Think and Write About...........................................................................197Chapter 13: Reconnecting with Loved Ones..................................................................198On the Outside Looking In.................................................................................199My, How You've Changed....................................................................................200Helping Loved Ones........................................................................................201When They Are Part of the Problem.........................................................................204Healing Your Relationships by Making Amends...............................................................205Ulysses and the Road Home.................................................................................207Things to Think and Write About...........................................................................208Chapter 14: Rebuilding the Spirit.........................................................................209Developing a Personal Spiritual Practice..................................................................209The Goals of Spiritual Renewal............................................................................211Out of the Monastery and into the Street..................................................................217Conclusion: Living with the Truth.........................................................................218Tragedy...................................................................................................218The Fundamental War Within................................................................................219Keeping Hope Alive........................................................................................220Gather Around the Fires...................................................................................221Recommended Reading.......................................................................................222Index.....................................................................................................224

Chapter One

Living in Troubled Times

Just after 9/11/2001, someone famously stated that "Everything had changed." What's changed now, a number of years later? Or, perhaps we should ask, what hasn't changed?

During World War II, GIs had a favorite word: SNAFU. It meant situation normal, all fouled up. It expressed the feeling that confusion, complications, and incompetence were normal and expected. In everyday life, not just the military, things usually do not go as smoothly as we would like. On the other hand, things seem to be particularly difficult nowadays. The GIs had another expression for times that go beyond the expected foul-ups, times when things are so bad we can hardly make sense of them. It was FUBAR: fouled up beyond all recognition. In some ways, the times we are going through seem to have moved from SNAFU to FUBAR. We can hardly recognize the world or remember how things used to be just a few years ago.

Sources of Uncertainty

Several years after the events of 9/11, how many people, even as far away as the West Coast, are still bothered by their reactions to that fateful day? According to one of the first long-term studies of the aftermath of the terrorist attacks, a great many folks are still shaken and are awaiting new attacks. Psychologist Suzanne Thompson, of Pomona College in Southern California, interviewed over five hundred people, none of whom even knew anyone in the attacks. Even after correcting for concern over the ongoing war in Iraq, Thompson found that fully 60 percent of the people she talked to expressed levels of fear and anxiety higher than they'd felt before the attacks. Many were afraid to fly in airplanes, were not reassured by increased security measures, and believed that they were vulnerable to another attack. Nearly 20 percent said they suffer ongoing reactions that are the same as they experienced immediately following the attack. For a great many Americans, the effects of 9/11 are not dissipating and, in fact, are more widespread than most recognize.

Hurricane Katrina stands as an example of one of the many events that have occurred since 9/11/01 that continue to aggravate our sense of personal vulnerability and social confusion. Katrina came as one of a set of unusually serious storms that many scientists link to overall global warming. Its initial fury was compounded by the breaching of levees protecting downtown New Orleans. The Federal Emergency Management Agency, led by a political appointee with no disaster experience, moved slowly to respond. This compounded the effects of the disaster upon the efforts of the already overwhelmed local governmental agencies. Charges of incompetence and cronyism were further complicated by allegations of favoritism and racism. All of this was capped off by the noncompetitive awarding of millions of dollars in recovery contracts to friends of the administration for cleanup. The point here is not to blame officials for the mishandling of the incident. If only it were that simple! Rather, the real lesson to make clear is why the individual dramas lived out among the thousands of suddenly homeless and displaced survivors are so poignant to the larger society. Events never take place in a vacuum, even events that seem out of control. Victimization occurs in a context. Even those who were not directly affected watch on. If it can happen to others, they reason, it could happen to me. The effects of Hurricane Katrina further undermine our belief that we are protected by our social structures.

Living in Fear: The Effects upon Our Health

When we live in constant dread of further catastrophe, our health is affected. Fear, uncertainty, and loss create stress. Yet the specific ways in which we are affected are often confusing, both to us and to the professionals who try to help us. Symptoms pile upon symptoms in ways we have difficulty understanding. Old diagnostic categories sometimes just don't fit.

Suppose you have been experiencing shortness of breath, difficulty sleeping, obsessive thoughts about new terrorist attacks, fears about the future, problems relating to your family, loss of interest in your job-and you figure the whole world is going down the toilet. A doctor tells you that you are suffering from stress and ought to slow down. (Not so easy to do when you have to pay your mortgage, hold down your job, or put your kids through school.) Another doctor tells you that you are suffering from anxiety. She gives you antianxiety medication. It doesn't help. So you go to a third doctor who says you are depressed and prescribes an antidepressant. Meanwhile, your spouse is insisting you meet with a family therapist. How can these people draw such different conclusions from the same symptoms? More to the point, what do you do when things are unbearable, but none of the normal categories or cures seems to fit?

Is It Stress or Trauma?

The concept of stress first emerged as a corporate issue in the 1970s. In that context, stress was seen as the chronic activation of the body's fight-or-flight reaction in response to work-related demands, such as performance pressure, too many hours, difficult working conditions, etc. In the 1980s and 1990s the use of the term stress was generalized to describe people's reactions to an assortment of fairly common events, such as life-threatening disease, family difficulties, and addictions. Seen in this light, the reactions many of us have to the unwinding of our way of life seem to be much more than a case of stress.

Our reactions also seem to be more than general anxiety. Fear reactions abound, with good reason. On both an individual and a collective level, we respond to reminders of our situation in one moment by experiencing agitation and intense reactions, and in the next moment by sliding into numbness and withdrawal. To me this looks more like traumatic stress than it does mere anxiety.

Indeed, the concept of traumatic stress provides a helpful perspective on our contemporary malaise. During the 1980s the media popularized the notion of psychological trauma as a stress reaction to extreme events. Trauma was initially described as a reaction suffered by some veterans of the Vietnam War. Then it came to be seen as a reaction to a single-incident, high-intensity event, such as a devastating automobile accident or a personal assault. Finally, the term trauma was extended to encompass reactions to ongoing (chronic) experiences like incest, child abuse, or domestic violence. Trauma resulting from such events is a classic, clinical reaction to extreme experiences.

VIVIAN'S STORY

Vivian Jackson works as a hairstylist in an upscale salon in a Chicago suburb. She has two children in elementary school and a husband from whom she separated four years ago because he had physically abused her. Vivian works hard to pay the bills, be a good mom, and still have time for friends. The divorce is pending despite the fact that both of them want it. Vivian can't face a court appearance, and the mere thought of finally being free from Bob-no matter how difficult their life together was-sends Vivian back to her therapist. The morning of 9/11 just about sent her back to Bob. She was on her way to work when her mother called on the cell phone and told her to turn on the news. Not only had New York been hit, it was thought that the Sears Tower in Chicago was the next target. Vivian immediately headed back to school to pick up her children. The next several hours were a nightmare. If her mom hadn't come over, Bob would have, and Vivian would have let him. Since then Vivian has experienced anxiety attacks and has fought to maintain her sense of direction. She has watched her community change, her financial situation grow precarious, her children's school deteriorate, and her country go off to a war she doesn't understand. She has frequent headaches, she feels numb and disconnected, and things simply don't make sense to her anymore. Most of all, she fears for her children. She lives on constant alert for signs of further terrorist activity. Vivian is putting on weight (a proven reaction to chronic stress) and losing interest in things that used to excite her. She scans the headlines every morning but then quickly turns to the comics section. She doesn't trust politicians and avoids talking about world events with others because doing so just makes her mad. Vivian often quotes a friend who is only partly joking when she says, "Depression is anger without enthusiasm."

Vivian is not alone. According to the professional literature, websites, the news media, and reports from individuals in therapy, a great many people are reporting

constant anticipation of impending disaster

a preoccupation with televised news

flashbacks and replays of terrorist strikes

intense anger and irritability at home or on the road, often misdirected at others

pessimism about the future

nostalgia or flights into sentimentality

fear for loved ones and their futures

alternating between overprotective parenting and feeling that nothing really helps

problems sleeping, nightmares, and strange dreams

chronic anxiety and depression

specific fears

vague but pervasive feelings that something is deeply wrong

changes in behavior and lifestyle

a philosophy of "live for today and let tomorrow take care of itself"

feelings of futility

questioning of personal values and directions

weight loss or gain

a compulsive desire for comfort food or familiar rituals

a desire to be rescued

marital and relational difficulty

exhaustion

desperation

a sense that everything can change in a minute, that nothing is permanent

Many of these reactions look like traumatic stress. Certainly, reactions of fear, anticipation, and anger resemble trauma, particularly if they alternate with feeling disconnected, exhausted, and depressed.

Contemporary Angst and Personal Crisis

About a hundred years ago, European writers coined a term that seems more fitting now than it did then. Angst refers to the dread and anguish we feel when we realize that things around us are spinning out of our control, but that we must act anyway. Sociologists used the term to describe how ordinary citizens felt as they watched their old ways of life destroyed by the powerful forces of impersonal industrialization. Now we feel a similar sense of loss, disconnection, and vulnerability. Political, economic, and technological forces beyond our influence increasingly shape our world. We feel powerless to protect our families-and ourselves-in any meaningful way.

This is the context, then, in which unfolding events mix with past experiences, contemporary angst, and everyday crises to produce the blend of symptoms we struggle to understand. It is our job to survive-and to survive meaningfully. To do so, our task is to sort through our reactions, learn how they are formed, and find ways to address them.

Chapter Two

Your Personal Response to Tragedy, Terror, and Uncertainty

The world is more confusing and frightening than ever. And we are certainly more confused and frightened. We go through our days acting as if everything is all right but waiting anxiously for the next turn of events that could throw our lives even further off balance. The "new normal" we hear about doesn't feel normal at all. We ponder the absurdity of things like government announcements that the threat level has been raised to "very high" and that we are to simply go about our business as usual with a "heightened sense of awareness." Times like these can make a person crazy!

Life is never really easy. It continually brings challenges-during the best of times and these not-the-best of times. Regardless of the state of the world, people get sick, lose jobs, get into accidents, and have family problems. We get overwhelmed, anxious, or depressed. We have midlife crises. All of these trials of living play out against the backdrop of the times in which they occur, and are colored by them. Sometimes it is hard to discern whether individual reactions-anxiety or depression, for example-are the result of larger community events or are simply made worse by them. It can be very confusing.

If we seek to address the issues in our lives that we don't like, we must begin by gaining clarity about just what is going on. This chapter invites you to take a serious look at the specific ways in which you are being affected by the events in your life, large or small, whatever their origins.

Nothing Occurs in a Vacuum

Whatever trials we face within our own souls, these trials are shaped by circumstance. Whether we struggle with anxiety, panic, failure of nerve, or temptation to drink or behave badly, our personal drama plays out on a particular stage. To understand our trials we must first place them within their context. If you think about it, it makes sense that global, national, and community events have had an impact on your life. You have probably felt some changes in your family, neighborhood, and workplace since the 9/11 attacks, and these changes have probably had an effect on you. But people react to different things. Which particular changes are key to understanding you and your responses?

Your Personal Sense of Well-Being

Political challengers often ask voters, "Are you better off now than you were four years ago?" Such questions press home the issue of overall well-being. Well-being is a blanket term that covers your sense of security, comfort, and general happiness. While everybody's sense of well-being has been affected by the events of the past several years, specifically how you are affected depends upon your individual situation. Consider the following cases of Bob Searles and Maria Chavez:

Prior to 9/11, Bob ran a small-parts distribution business. His clients were larger companies that provided the myriad parts needed in aircraft assembly. In the aftermath of 9/11, aircraft production slowed, as did the demand for Bob's parts. By the fall of 2002, his business had just about bottomed out, and so had Bob. On a one-to-ten scale measuring well-being, with ten being the highest sense of well-being, Bob's feelings hovered at around two. He was depressed, suffered from low self-esteem, and was pessimistic about his future. He felt inadequate to continue what he was doing and too old to try something new. By the fall of 2003, however, aircraft production had begun to climb again. Job orders were trickling in, and Bob's efforts to develop interests beyond his business were paying off as well. His sense of well-being began showing signs of recovery. The events of 9/11-while distressing-initially had a lesser impact upon Maria. A teacher in California, Maria had always felt a deep sense of mission that, if anything, was strengthened after the attacks. During the fall of 2002, Maria's sense of well-being was at least a seven on the same ten-point scale. But when California was battered by energy and financial scandals, and the political maelstrom that followed, the state's educational spending plummeted. Programs were cut back severely. Suddenly Maria had about 50 percent more students in her classes, many of whom were facing a bleak future. Soon after, Maria was notified that she was being moved into an inner-city school marked by violence, where she was asked to teach subjects for which she was poorly prepared. By the fall of 2003, she was losing both her sense of mission and her sense of well-being.

Both Bob and Maria were profoundly affected by events far beyond their control. They reacted differently because the 9/11 attacks affected their daily lives differently. As the level of stress in their work situations changed, both experienced shifts in their sense of well-being.

Consider where you stand right now. Do you feel-in general-that things are okay? Are you reasonably comfortable, and do you feel fairly secure? Do you feel good about yourself and optimistic about the future? Has your level of well-being changed over the past few years?

(Continues...)

Excerpted from After the Stormby Kendall Johnson Copyright © 2006 by Kendall Johnson, Ph.D.. Excerpted by permission.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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