Paul Little: Trauma? PTSD? Actually, no – stop catastrophising!


The apocalypse is apparently upon us. A pandemic, climate change, social collapse -existential threats are many and real. It all sounds very traumatic. And yet it’s not. Despite the readiness with which people say, “That was traumatic” or “I was so traumatised”, when a bad thing happens, it usually wasn’t and they usually weren’t.

Where the word was once used to describe experiencing or witnessing events that were sudden, violent and threatening, it is now used to describe not being allowed to leave the house for a few weeks.

As Lucy Hone, co-director at the New Zealand Institute of Wellbeing & Resilience and adjunct senior fellow at the University of Canterbury, says: “Humans are hard-wired to cope with all types of adversity, including the pandemic, including horrible sustained lockdowns. That doesn’t mean it’s fun doing it. It is just that people should understand that their hatred of lockdowns and their struggle over all of the things that the pandemic has done to us is quite normal. Lockdown conditions are the opposite of what we are designed for, which is to live outdoors in almost perpetual motion.”

Struggling and feeling bad is to be expected, says Hone. “I am not diminishing it, not belittling how hard that is, but when you find yourself really frustrated, low and miserable in a lockdown, that is the correct psychological response.”

Increasingly, though, it is assumed that if something bad happens to you, you will experience trauma. And it is further assumed that this will inevitably lead to PTSD.

In fact, epidemiological research conducted over decades shows that, rather than falling into a life of flashbacks and sleeplessness, around two-thirds of us shrug off terrible events and get on with things quite quickly.

And as Hone implies, this is not due to tough love or being told to get over it or the practice of stiff-upper-lipness. It is due to innate human qualities that we all have but which we have recently started to overlook.

Recent events have demonstrated this repeatedly. Following the events of September 11 2001 in New York, counselling units to deal with the traumatised were quickly organised. Counsellors sat primed and waiting. And waiting. And waiting. A few people sought help, but nothing like the numbers expected. Because most people were not traumatised.

A few years later and it seems the psychology community hadn’t got their heads around this. Mental health services everywhere expected terrible fall-out from Covid-19 and Delta and put plans in place to deal with it. Again, they built them but nobody came.

George Bonanno is Professor of Clinical Psychology at Columbia University and the author of the recently released The End of Trauma: How the New Science of Resilience Is Changing How We Think about PTSD. He chooses his words carefully. He prefers, for instance, to talk about “potentially traumatic events” rather than traumas.

“The epidemiological data show most people will experience one or more of these events in their life,” says Bonanno. “Ask anyone off the street if they have ever had one of these events and if they talk long enough they will remember. I’ve had at least five. They were disturbing at the time but only for a day or two or three.”

As for PTSD, Bonanno says research going back decades overwhelmingly shows that trauma itself does not predict the likelihood of PTSD: “Having exposure does not make you vulnerable.”

He lists three main reasons why people are so quick to believe they have been traumatised.
The first is that it got given a name. “Once it was formalised by the Diagnostic and Statistical Manual of Mental Disorders in 1980 there was suddenly a rush to use it: ‘We have a diagnosis. Let’s treat these people.'”

The next problem was that researchers focused all their attention on people with PTSD. Hardly anyone was looking at the far greater number who did not develop the condition, so hardly anyone was giving any thought to what prevented it.

The second factor Bonanno cites is the media, mainstream and social. “No one ever says that something happened and everything is okay. Bad things keep getting repeated until the news cycle changes. Things on Facebook get people riled up so the story spreads further.” And it’s those who are suffering who want to tell their stories. Not many people who are feeling fine have a need to share about it at length.

Bonanno says our brains are also at fault: “We are wired for threat. When we read horrendous things, they capture our attention.”

“When we sense danger, the first thing we reach for is more information.” echoes British clinical psychologist and columnist Linda Blair. “The news is generally accurate, but when you think of how many stories are possible and which ones are chosen then you understand that it isn’t about proportionate information.”

Lucy Hone is looking at you, social media, displaying only the bright shiny parts of people’s lives and pretending the dark does not exist: “The era of perfectionism and entitlement that we live in means we have lost the ability to struggle and suffer. Some things get labelled PTSD when it is just having a bad time, and being miserable. Humans have dealt with that kind of struggle and been forced to live through tough times throughout history.”

She faced huge challenges herself dealing with the trauma of her 12-year-old daughter Abi’s death in a car accident in 2014. But she says she does not have PTSD.

“I did experience some symptoms of PTSD temporarily,” says Hone. “Partly because I lived through the earthquake too, then later came the mosque shooting and Covid. Every time, I get the same symptoms of hypervigilance, being really widely alert, and I feel very vulnerable and startle easily. But I don’t have PTSD, because those symptoms are temporary.”

For those people who do get PTSD, putting its prevalence in perspective will enable the efforts to go where they are needed.Increasingly those studying the field are talking about a positivepost-traumatic reaction:

“Health practitioners and media and the general populace need to know there is more than one option when you go through tough times,” says Hone. “Sometimes tough times can lead to what psychologists refer to as Post-traumatic Growth.”

Californian clinical psychologist Jessica del Pozo is one person working in the area who believes trauma can leave us better off, discovering things about ourselves from a negative experience.

“The literature supports that much of the time,” she says. “Growth follows depression and despair, although they may be stages along the way. Many combat veterans report post-traumatic growth,and many people say they wouldn’t give up their trauma. Not that they would choose to have it again, but the fact is it happened, so what are we going to do with it? If we can’t see that growth can come from trauma, we are screwed.”

So, given the scary stuff isn’t going to stop happening any time soon, how do the potentially traumatised prepare for it and the growth that can come from it.

Resilience and flexibility are the two important qualities Bonanno writes about extensively at The End of Trauma. Put briefly: resilience is our ability to cope with bad things, flexibility describes the skill set we use to get there. It is not a superpower.

“Research shows most people are at least moderately flexible already,” says Bonanno, describing it as including such traits as “optimism for the future, confidence in our ability to cope and a willingness to think about a threat as a challenge.”

“When Abi died,” says Lucy Hone, describing how she rose to that challenge, she made herself get out of bed “as many days as I could, to do what I could. It’s the same with Covid and any other adverse events. People who cope best, demonstrating the highest capacity for resilience, are those who are able to do whatever it takes to get through. Often we see they have pragmatism combined with optimism.”

Blair says doing something that can help – anything – at the time of the crisis will ease your sense of helplessness. “If you immediately start trying to think of how to fix it – even if it doesn’t work – you are asserting some control over the situation.” And try to put it in context. “We have hard evidence through lots of longitudinal studies that it is not what happens to you in life that determines your happiness – it is how you evaluate it.”

Talking and writing about your experience are cited by many experts as good ways to gain perspective.

“Start talking about it mindfully, choosing who you are talking to,” says Del Pozo. “Writing and then looking at your story can be really powerful. You can practise retelling the same story from different perspectives. You might see yourself first as the victim in the story but later as the resilient hero who survived. The bottom line is you did survive. It took some internal resources to pull you through that.”

And be realistic in your expectations, says Wellington clinical psychologist Dr Sarb Johal author of the forthcoming book Finding Calm. He describes post-traumatic growth in terms of resilience: “Resilience is not about bouncing back to where we were, it is about what we have learned about what has kept us safe and kept us well. What can we do to apply what we have learnt about what keeps us well in the future? Resilience is about adapting, not about bouncing back.”

A sense of purpose is also helpful, says Johal. You’re not going to work hard to get over something if your life isn’t a fulfilling one that is worth fighting for. He notes recent research and thinking have highlighted that many are missing a sense of purpose. “If you are spiritual, it is the cosmos or a being. For someone not that way inclined, it can be charities or doing work in your community, contributing to something bigger than you, where you can see your contribution adding to the result.”

Kelsey Waghorn was a guide working on Whakaari White Island at the time of the eruption that killed 22 people in December 2019. The disaster left her with full-thickness burns to 45 per cent of her body, PTSD and a lot of recovering to do. Much of what she describes confirms the views of the experts about the best ways of dealing with trauma:

“For me, it was April when it first started dawning on me – four months after the eruption. It didn’t feel real or as it had happened to me – that was the PTSD symptom of dissociation. Then we had the first level 4 lockdown. Over that time, with not being able to be with family, it hit me, and I started getting flashbacks and life just got a bit harder all of a sudden. Those things might have sped the process up a bit.

“When I started hearing Covid was in New Zealand it was the only thing people talked about. I was still in bandages and I couldn’t wash my hands properly, which was a big rigmarole. A lot of the things they said you should do for Covid I couldn’t do, and that was frightening. I felt I was sure to get it.

“Everyone has said: ‘You are so positive,’ which I really don’t like. I’m not always positive about all of this, because that is not realistic. I’ve tried to be realistic the whole way through.
“PTSD was quite likely. I had been warned – if you start having symptoms, talk to someone and don’t try to cover it up. Being realistic is my biggest tool.

“It was about working out what I could do and doing it. When I couldn’t use my hands for a lot of things, it was really hard. Putting things into context and controlling what you can is big for me. When I get stressed, everything needs to be in its place, but the world was not going to end because the dishes weren’t done. If all I could do one day was eat an apple, that was fine.

“I had a ton of physical and mental goals. But getting through my PTSD has no time stamp. That’s a forever goal.”

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