By Mary C. Zeng, MD
November and December have been months of trauma.
The Paris terror attacks and the American shootings in San Bernardino and Colorado Springs have taken a heavy toll on both survivors and witnesses. Media coverage depicting scene after scene of carnage has also generated painful and lingering emotional reactions by secondhand exposure. A recent New York Times article describes “a creeping fear of being caught in a mass rampage has unmistakably settled itself firmly in the American consciousness.”
It’s true that trauma breeds fear. Those who were directly victimized in the attacks are, of course, likely to develop both short- and long-term fear reactions. But even indirect victimization, such as through the media, can be psychologically damaging. One study of New Yorkers after Sept. 11 found that people who watched more news coverage were over three times more likely to develop post-traumatic stress disorder (PTSD), a hallmark disease of fear.
However, if we are to truly understand and appreciate each other’s emotions during these troubling times, we must talk beyond fear. Failure to do so would be a disservice to those who are suffering.
A variety of responses is expected, and normal, in the aftermath of trauma. Fear is only one of several emotions that may arise — one of a cluster of experiences collectively known as peri-traumatic distress. Other feelings in this cluster include helplessness, sadness, grief, guilt, shame, anger and horror. Certain cognitive responses, such as a worry about fainting or dying, are also common, as are physical sensations such as loss of bowel or bladder control and shaking, sweating or a racing heart.
Another common response immediately following a trauma is peri-traumatic dissociation: a state of disconnectedness from oneself or from reality, memory loss, reduced awareness or time distortion that is triggered by a traumatic event.
Both of these sets of responses are normal short-term reactions to trauma. They may be experienced with varying levels of intensity, depending on how directly or indirectly someone was exposed to the trauma. They are expected to phase out, or extinguish, for many people over a course of weeks after the traumatic event.
It is when these reactions do not extinguish that the long-term and potentially crippling effects of trauma begin to show in individuals with a genetic predisposition. Peri-traumatic responses then turn into PTSD, a psychiatric illness affecting 7-8 percent of all Americans over their lifetimes. The classic signs of PTSD, aside from exposure to a traumatic event, include intrusive memories of the event; avoidance of people, places and situations associated with the event; negative mood and cognitions; and hypervigilance and hyperarousal.
In the same way that a veteran who saw IEDs in Iraq now sees IEDs everywhere, the mass shooting survivor forgets how to feel safe even on the home front. The world turns into a permanently dangerous, uncontrollable place.
Besides peri-traumatic distress, peri-traumatic dissociation and PTSD, which are widely researched because they can lead to psychological disability down the line, a whole range of emotions is possible in light of the recent tragedies. Numbness, bewilderment, resignation — there is no one right way to react to trauma. Traumatized individuals are also at higher risk of developing psychiatric disorders other than PTSD, such as major depression and substance abuse.
But positive adaptations to trauma have also started to receive research attention.
Adaptations such as resilience, the ability to “bounce back” after stressful life events, and post-traumatic growth, the range of positive psychological changes that occur following trauma, have both been shown to be common — and, importantly, learnable.
Combat, for instance, is also an example of how people placed in traumatic situations can form deep connections. As one veteran said: "People bond incredibly quickly while deployed. You're in a place with no one you know, and people are trying to kill you."
Relationships can be enhanced as a result of trauma, people start to value their loved ones more, and develop closer ties to each other as a result.
And while post-traumatic disorders such as PTSD can be debilitating if untreated, recognizing the symptoms goes a long way in reducing suffering. There are effective and evidence-based treatments for PTSD and other mental illnesses. Contact your doctor if you or someone you know is experiencing a difficult time after trauma.
And be there for that person. There is no substitute for human understanding, empathy, and warmth at times like these. One great therapist said, “People look after each other, if you let them.”
Fear may have settled in for some, but it’s not the only response that we should know, and there are ways to fight it. In the wake of these tragedies, let’s not breed hostility and hysteria by giving in to fear. Let’s use our resources to increase our resilience and post-traumatic growth as a nation — which starts by looking after each other.
Mary C. Zeng, MD, is a clinical fellow in psychiatry at the Massachusetts General Hospital.