More of us need to learn about trauma

I am writing today about my favourite topics:  Trauma and Post Traumatic Stress Disorder (PTSD).

Trauma is an event in which you or a loved one is in significant danger. Think rape, robbery, war, earthquakes and serious motor vehicle accidents.

PTSD is a reaction to trauma. It typically includes flashbacks to the moment of horror, where you feel like the horror is happening again and again in the present. It also includes graphic nightmares with themes associated with the trauma (running, crying screaming). Alongside this, people with PTSD also experience high levels of day-to-day anxiety, hypervigilance and dissociation (spacing out or numbing).

PTSD gets a lot of airtime in the field of psychology, and is now very well understood in therapy circles. Therapists offer trauma therapy in the form of EMDR, CBT, AEDP and other modalities for the common symptoms of PTSD.

However, trauma needs to be far better understood outside of these circles, particularly amongst professionals who deal every day with vulnerable people

In my 15 years as a therapist, one story stands out:

The client was a young woman in her early twenties who had been sexually assaulted while inebriated in a bar. A man much bigger than her forced himself on her after following her to the bathroom. Wanting to deny the experience, she turned down her flatmate’s offer to contact the police, preferring to sleep it off and deny it ever happened. A few months later, she experienced another incident of assault when a man grabbed her breasts and then her bottom on a crowded dance floor.

This time, the post-traumatic reactions hit hard. While she managed to function before, she now struggled to sleep at night for fear of the nightmares. She struggled to stay focused at work because of flashbacks and a tendency to dissociate. She became forgetful and fearful at work and at home, and eventually suicidal.  

Like so many victims of sexual assault, she felt intensely embarrassed and thinking that maybe she “asked for it” because of the way she dressed, or how much she drank. As I got to know her, it became very clear that she had done nothing wrong.

One day, weeks before our first session, she finished a whole bottle of wine by herself, wanting to block out the feelings of shame and “dirtiness” that each flashback brought.

Still distressed, she cut herself badly, first as a way of changing the way she was feeling. Cutting is often about converting seemingly intolerable emotional pain into more focused physical pain.

But then, she cut herself more deeply. She had initially hoped to die, but got scared by the bleeding, and realised just how much damage she had done.

She called the ambulance to get help. Seeing that she had attempted suicide, the paramedics put her into the ambulance and brought her to hospital to check her wounds and consider psychiatric care.

While this was all routine, my client recalled tearfully that not once did either of the two seemingly nice paramedics look her in the eye, or acknowledge her presence. Doing their job professionally, they dressed her wound mechanically, and asked her simply to follow them into the ambulance.

In the 20 minutes ride, the client described feeling worse than she had ever felt. She received similar treatment in the emergency room – quiet efficient care, but no eye contact.

She felt shame, like a red-hot spear through her heart.

In the weeks that followed, she started to feel more and more unworthy and deserving of contempt. First for putting herself in the position of being sexually assaulted, and then self-harming, and needing medical help.

These feelings continued, and she came to see me after a second unsuccessful suicide attempt.

While we worked through her trauma, and the magnitude of misplaced blame and shame she felt, what stood out for me was the fact that the treatment she got from the paramedics cut deeper than the actual assaults.

Their inability to connect with her empathically felt like blame, and this reinforced her feelings of unworthiness and shame.

Curious about my client’s experience, I asked a few people in the helping professions about this, and they all gave me knowing nods.

One experienced social worker explained, that if my client had been an old person or a child, the paramedics would most likely have been more kind, cheerful and upbeat, sympathetic to her despair.

But because this was self-harm ond suicide, they themselves became emotionally overwhelmed, and perhaps had to block her out to stay focused on the task.

Another explanation was that they were afraid of saying the wrong thing and upsetting a vulnerable patient further.

But as my client’s experience shows, not saying anything at all is far worse.

For the sake of our helping professionals who see and hear so much in the course of their work, and for their clients, I’m advocating for trauma training as part of routine training.

Trauma is not just the domain of us mental health professionals. In the next blog, I’ll talk more about how trauma presents in schools, and how teachers and educators often miss the first principals of learning – the need for Attachment and emotional safety.

Please contact me at dramrit.sg@gmail.com if I can provide trauma training to you or to your team.  

https://dramrit.org/contact

(Please note that personalities and places are modified or amalgamated in these stories to make a point and protect the privacy of clients)