EDITORIAL NOTE
This article is the second in a four-part series on ministering to those with mental health issues.
The Bible is filled with stories of trauma, but also of perseverance after trauma. Adam and Eve suffered the loss of a son in a cruel murder. The murderer was their other son. Noah and his family knew, as they heard water flood the world outside, that family and friends were drowning all around them. Joseph was mercilessly betrayed by his own family, sold into slavery, falsely accused, and suffered for years in prison. Moses killed a man with his own hands and fled for his life. David was hunted, but he also had lots of blood on his own hands. His daughter Tamar was raped by one of his sons. The Israelites killed and were killed in countless wars. Mary, the mother of Jesus, saw her son tortured and executed in a most gruesome way. And there are many more stories of abuse, cruelty, and loss of life.
Since creation, we have desired to be loved, to be safe, and to be happy. That’s what we were created for. Sadly, we live in a world where we all, sooner or later, experience hurt, harm, and death. Trauma is the result of painful and frightening events that emotionally overwhelm us and affect our capacity to cope. They are unbearable and intolerable experiences. Trauma leaves a lasting impact on how we feel, think, act, and relate.
Trauma is not only about what happens to us, but also about what happens inside us as a response to a traumatic event. Two people who experience the same event may have very different responses. Still, neglect, abuse, or violence—whether physical, emotional, or sexual—often result in trauma. Other traumatic events are accidents, natural disasters, war, or seeing something terrible happen to a loved one or someone else. Research indicates that 70% of us experience at least one traumatic event in our lifetime.
What characterizes trauma is that it isn’t over when the traumatic event itself is over. It continues to live within us as memories, dreams, and flashbacks. We may live with constant stress. We are on the lookout for threats and danger. We feel that something bad could happen any time. And we’re easily triggered.
For the traumatized, the world feels like an unsafe place. Life becomes about how to survive. The effects of trauma may endure for weeks, months, years, and even decades. They affect how we see ourselves, how we see others, and how we see the world. Trauma may become the filter—the glasses— through which we see and experience practically everything.
People who have survived trauma often blame themselves for being weak, think it was their fault that they couldn’t protect themselves or others, and may even feel responsible for what happened. Often, they have a deep sense of guilt and shame. They may think they are worthless, wrong, and damaged. For someone who has suffered trauma, it’s important to get to the point where they can say, “I am not bad. But I struggle because something bad happened to me.”
WHAT ARE THE SYMPTOMS OF TRAUMA?
After a traumatic event, some recover quickly. Others do not return to normal; they keep living as if the traumatic event never ended. They have become traumatized. The core symptoms of post-traumatic stress disorder, or PTSD, are:
- Intrusion. Unwanted memories that suddenly intrude into the present moment; recurring dreams or nightmares; flashbacks where one feels and acts as if the event is happening right now.
- Avoidance. Attempts to avoid any distressing memories, thoughts, feelings, and reminders of what happened.
- Hyperarousal. A state of chronic stress where the person often has heightened alertness, is easily startled, has increased irritability, and problems with concentration and sleep.
- Numbness. Feeling distant and detached from almost everything, including oneself. It may be difficult to connect in important relationships. It may be hard to feel anything except fear, anger, guilt, and shame. Interests and activities that used to be important and enjoyable may not feel significant anymore. Even the memory of the traumatic event may be fragmented and incomplete. A severe form of numbness is dissociation. Dissociation is a disconnect from reality. One feels disconnected from one’s own mind and body, and from time, space, and what’s going on around. Things may feel unreal and dreamlike.
When such symptoms last for more than a month after a traumatic event, and cause significant distress or impaired functioning, then it may be PTSD. And when there have been repeated traumatic events, prolonged trauma, and especially childhood trauma, one may develop complex PTSD, a severe form of PTSD.
WHAT ARE THE COMMON CAUSES OF TRAUMA?
Globally, around 4% will experience events that are so distressing, threatening, and overwhelming that they will develop a posttraumatic stress disorder. From research, we know that sexual violence, such as rape and other kinds of sexual abuse and assault, is the leading cause of PTSD. Sexual violence is all about violence, and very little about sex. It’s one of the most evil and hurtful things people do to others. Claims of sexual violence are usually true. They should not be dismissed without careful consideration. Any kind of sexual violence or harassment should never be tolerated or excused.
The second leading cause of PTSD is domestic abuse. These are behaviors that frighten, intimidate, terrorize, manipulate, hurt, humiliate, blame, injure, or wound someone close to us. For each person traumatized in war or conflict, there are many more who are traumatized within the walls of their homes by someone who should have loved and protected them.
One of the most common traumas is unexpected loss of a loved one. It can lead to complicated grief and PTSD. Other major causes of PTSD are traumas related to war and conflict, witnessing something terrible happening to others, experiencing physical violence, accidents, and disasters.
In general, the more intense or long-lasting the traumatic event was, the higher the risk of PTSD.
WHO ARE MOST VULNERABLE TO BECOMING TRAUMATIZED?
In general, men experience more traumatic events, but females are more likely to develop PTSD. Other vulnerability factors are:
- younger age;
- having experienced earlier traumas, including adverse childhood experiences;
- previous mental health challenges and substance abuse;
- lower socioeconomic status; and
- lack of social support.
In this world, the reality of trauma is something we all should care about. Many traumatic events involve people willfully hurting others. Instead of hurting each other, we should protect one another and prevent unnecessary suffering. And we should be kind, compassionate, and supportive of those who suffer from trauma.
WHAT THE TRAUMATIZED NEED
Experiencing something traumatic impacts us deeply. Healing from trauma is about reclaiming your mind, body, and relationships, and managing how you feel, think, act, and relate. Someone who is suffering from trauma should not have to struggle with it alone. They deserve and need social and professional support.
The goals in trauma recovery are to stay safe, be able to manage the symptoms, process the trauma memories, be fully alive in the present, and enjoy fulfilling relationships with other people. To feel safe, any ongoing trauma must stop. Whenever traumatic events are ongoing, it is the natural and healthy response to be on the alert and feel unsafe.
After a traumatic event, being with loved ones and someone who holds one’s hand or gives a hug when it’s wanted, a safe place to stay, food, practical help, and time to rest and sleep may help minimize the impact of the trauma. In addition to the social support of friends, family, and the church community, it is recommended that the traumatized seek help and work with a trauma therapist to manage the symptoms and challenges following a trauma.
Depression, anxiety, eating disorders, addictions, self-harm, and suicidality are common symptoms in trauma. It is important to replace self-destructive survival strategies with healthy strategies for emotional relief and stress reduction. Medication can help make symptoms more manageable and may be beneficial in the recovery processes. But medication alone is not sufficient treatment for trauma.
Eventually it will often be necessary to work on the trauma memories. The goal is to be able to remember and understand relevant aspects of the trauma without becoming overwhelmed by emotions or bodily reactions. In processing trauma memories, it’s essential to pace oneself under the guidance of a therapist so it won’t be too much too soon.
Traumatized people often feel detached from their thoughts, feelings, body, other people, and the world around them. The goal of trauma recovery is reconnecting and becoming fully alive in the present. For this to become a reality, one needs to develop self-awareness and mindfulness, becoming fully present in one’s mind, body, and the environment; to notice and reflect on what is going on inside and around oneself. Many people find that deep breathing, relaxation techniques, stretching, walking, and nature help them become more aware and grounded in the present. When one becomes open and sensitive to what is going on inside and around, one will feel more alive.
Ultimately the goal is to truly enjoy safe and fulfilling relationships again. To feel physically and emotionally safe, we need people in our lives who are available, sensitive, and responsive—people who come close and provide support when we experience fear and pain.
Family, friends, therapists, support groups, and religious communities may provide that. For some, bonding with a dog, a horse, or some other animal may also be a way to experience closeness to another being. Being connected and supported is a powerful protection against becoming traumatized, and it is essential for recovery. Even if someone has been alone and lacked support in the past, it is never too late to connect. Being loved, supported, and close to people who are available, sensitive, and responsive is healing. Recovery happens in relationships.
WHERE IS GOD?
And, ultimately, where is God for the traumatized? Where was He when the traumatic events happened? We know that we are living in the great controversy between good and evil, and no one feels this more acutely than the traumatized. God’s will is not hurt, harm, or death. But we’re still in this world of sin. And, as long as we are, it is my conviction that any time someone is traumatized, God is right there and suffers with the sufferer. Through the prophet Isaiah He speaks these words of comfort, courage, and hope to the traumatized:
Don’t be afraid, for I am with you. Don’t be discouraged, for I am your God. I will strengthen you and help you. I will hold you up with my victorious right hand (Isa 41:10, NLT).
He will not crush the weakest reed or put out a flickering candle. He will bring justice to all who have been wronged. He will not falter or lose heart until justice prevails throughout the earth (Isa 42:3–4, NLT).
Torben Bergland, MD, is a psychiatrist and an associate director of Health Ministries at the General Conference of Seventh-day Adventists, Silver Spring, MD, USA.
