Questions.Questions.

1.1. How does trauma affect individuals?How does trauma affect individuals?

2.2. How does it affect others?How does it affect others?

3.3. What might be the consequences?What might be the consequences?

Trauma? What trauma?Trauma? What trauma?

In The Times newspaper a doctor, speaking In The Times newspaper a doctor, speaking

about trauma, was reported as having said:about trauma, was reported as having said:

“ “The word The word shock shock should not be used by lay should not be used by lay

people. Instead they should use the wordspeople. Instead they should use the words

an unpleasant surprisean unpleasant surprise”.”.

Post-Traumatic Stress Disorder - 1980Post-Traumatic Stress Disorder - 1980..

Diagnostic symptoms from D.S.M. IV.Diagnostic symptoms from D.S.M. IV.

Re-experiencing.Re-experiencing.

Avoidance Behaviour.Avoidance Behaviour.

Arousal.Arousal.

Living with P.T.S.D. Living with P.T.S.D.

What is it like to have P.T.S.D.?What is it like to have P.T.S.D.?

What is it like to live with someoneWhat is it like to live with someone

who has P.T.S.D.?who has P.T.S.D.?

ReactionsReactions to Trauma. to Trauma.

1.1. Physical effects.Physical effects.

(a)(a) Listlessness / Fatigue. Sleeplessness or Sleeping. Exhaustion.Listlessness / Fatigue. Sleeplessness or Sleeping. Exhaustion.

Palpitations. Sweating. Headaches.Palpitations. Sweating. Headaches. Difficulty breathing. Difficulty breathing.

Pains in Stomach & Chest. Shaking. Imagined heart-attack. Pains in Stomach & Chest. Shaking. Imagined heart-attack.

(b)(b). Exaggerated Startle Response. Hyper-vigilance. Incessantly talking. . Exaggerated Startle Response. Hyper-vigilance. Incessantly talking.

Outbursts of Anger. Violence against objects or people. Outbursts of Anger. Violence against objects or people. Murder Murder

? ?

(c)(c) Lack of ability to communicate or make decisions. Not speaking. Lack of ability to communicate or make decisions. Not speaking.

Confusion. Physical and Social withdrawal. No physical affection.Confusion. Physical and Social withdrawal. No physical affection.

(d) (d) Triggered sensory reactions - sights, sounds, smells, taste, touch. Triggered sensory reactions - sights, sounds, smells, taste, touch.

(e) (e) Lack of care for self. Vagrancy. Not able to cope with work. Lack of care for self. Vagrancy. Not able to cope with work.

Suicide. Suicide.

(f) (f) Specific Specific Physical illnesses – ‘Gulf War Syndrome’.Physical illnesses – ‘Gulf War Syndrome’.

“ “Why do I react like this? I must be going mad”.Why do I react like this? I must be going mad”.

John’s Story.John’s Story.

1.1.

2.2. Psychological effects.Psychological effects.

(a) (a) Numbness. Disbelief. Fear. Acute Sadness. Panic attacks. Numbness. Disbelief. Fear. Acute Sadness. Panic attacks.

“ “It can happen again!” Increased Anxiety & Vulnerability. It can happen again!” Increased Anxiety & Vulnerability.

Inability to Concentrate. Depression. Pointlessness.Inability to Concentrate. Depression. Pointlessness.

(b) (b) Helplessness. Shame. Remorse. Bitterness .Helplessness. Shame. Remorse. Bitterness .

Blaming. Guilt & ‘Survivor Guilt’. “I could / should be dead!” Blaming. Guilt & ‘Survivor Guilt’. “I could / should be dead!”

Apathy. Despair. Low self-esteem. Lack of Self- Apathy. Despair. Low self-esteem. Lack of Self-

worth.worth.

(c)(c) Little or no sense of having a Future.Little or no sense of having a Future. “I am going to die soon”.“I am going to die soon”.

““I am useless. My family would be better off without me”.I am useless. My family would be better off without me”.

““Nobody can understand or help”.Nobody can understand or help”.

Reactions to Trauma.Reactions to Trauma.

Mary’s & Jamie’s Story.Mary’s & Jamie’s Story.

2.2.

3.3. Social Effects.Social Effects.

(a) (a) Inability to express love or affection. Physical withdrawal. Inability to express love or affection. Physical withdrawal.

Sleeping alone. Becoming silent and remote. Not talking.Sleeping alone. Becoming silent and remote. Not talking.

““It’s like living with a zombie or a time bomb waiting to explode”It’s like living with a zombie or a time bomb waiting to explode”

(b)(b) Talking about or obsession with or avoiding the event. Talking about or obsession with or avoiding the event.

No interest in usual social context – hobbies, people, events. No interest in usual social context – hobbies, people, events.

(c)(c) Lack of sympathy. Acting out of character. Impulsive actions. Lack of sympathy. Acting out of character. Impulsive actions.

Being unreasonable. Violence. Aggression. Anger.Being unreasonable. Violence. Aggression. Anger.

(d) (d) Flash-backs. Vivid Dreams. Frightening / Horrific Nightmares.Flash-backs. Vivid Dreams. Frightening / Horrific Nightmares.

(e) (e) Inability to cope with work, relationships and life in general.Inability to cope with work, relationships and life in general.

Increased use of alcohol and tobacco and use of drugs.Increased use of alcohol and tobacco and use of drugs.

“ “I just can’t cope. Nobody understands. Leave me alone”.I just can’t cope. Nobody understands. Leave me alone”.

Reactions to Trauma.Reactions to Trauma.

David’s Story.David’s Story.

3.3.

Possible Responses from Partners & Others.Possible Responses from Partners & Others.

(a)(a) Anger. Anxiety. Frustration. Fear. Apathy. Anger. Anxiety. Frustration. Fear. Apathy.

Shame. Guilt. Sadness. Helplessness. Hopelessness. Shame. Guilt. Sadness. Helplessness. Hopelessness.

Depression. Depression.

(b) (b) Distancing. Ignoring. Avoiding. Rejecting. Self-blame. Distancing. Ignoring. Avoiding. Rejecting. Self-blame.

Bitterness. Despair. Confusion. Questioning sanity of Bitterness. Despair. Confusion. Questioning sanity of

self .self .

(c) (c) Questioning sanity of the person. “He’s / she’s going mad”.Questioning sanity of the person. “He’s / she’s going mad”.

Breakdown of relationships. Bitterness. Separation. Breakdown of relationships. Bitterness. Separation. Divorce.Divorce.

The symptoms can be similar to the symptoms of P.T.S.D.The symptoms can be similar to the symptoms of P.T.S.D.

“ “There’s nothing I can do. Trying to help doesn’t work”. There’s nothing I can do. Trying to help doesn’t work”.

“ “Nobody can help us - nobody can help me”.Nobody can help us - nobody can help me”.

Things said by those with PTSD.Things said by those with PTSD.

(a)(a) “If I talk to someone I love or know, they will think I am “If I talk to someone I love or know, they will think I am

pathetic and weak. Others might not or cannot understand or pathetic and weak. Others might not or cannot understand or

might become distressed. If I talk about it, it might also become might become distressed. If I talk about it, it might also become

too distressing for me and I don’t want to descend into being an too distressing for me and I don’t want to descend into being an

emotional wreck and, again, be seen as weak – so I just keep it emotional wreck and, again, be seen as weak – so I just keep it

all bottled up inside”.all bottled up inside”.

(b)(b) “What’s the point of carrying on when you have seen what I “What’s the point of carrying on when you have seen what I

have seen and experienced? Life’s just a sick joke without any have seen and experienced? Life’s just a sick joke without any

reason or purpose”.reason or purpose”.

(c)(c) “I should be dead. Why did I survive when they didn’t?” “I should be dead. Why did I survive when they didn’t?”

Things said by those who live with them.Things said by those who live with them.

““He’s useless, hopeless and a nightmare to live with. Why should He’s useless, hopeless and a nightmare to live with. Why should we have to put up with his behaviour? I get so angry and we have to put up with his behaviour? I get so angry and depressed and can’t see any future for us.”depressed and can’t see any future for us.”

““If I change anything in the house or do almost anything different, If I change anything in the house or do almost anything different, he goes mad, throws things around and walks out”.he goes mad, throws things around and walks out”.

““It’s the drinking, dark moods and the anger I can't stand. Sex It’s the drinking, dark moods and the anger I can't stand. Sex has gone out of the window. He just isn’t bothered any more and has gone out of the window. He just isn’t bothered any more and sleeps in the spare-room. I don’t want him near me anyway”.sleeps in the spare-room. I don’t want him near me anyway”.

““He never bothers with the children and just lives in a world of his He never bothers with the children and just lives in a world of his own. It’s as though he’s surrounded by a wall of silence. He own. It’s as though he’s surrounded by a wall of silence. He ignores me and the children but, worst of all, I’m terrified of his ignores me and the children but, worst of all, I’m terrified of his anger and violent behaviour. He hasn’t hit me or the children but anger and violent behaviour. He hasn’t hit me or the children but he almost goes out of his mind when he loses his temper”.he almost goes out of his mind when he loses his temper”.

What about the children?What about the children?

Children’s Reactions to Trauma.Children’s Reactions to Trauma.

Said in 1979 by an Indianapolis boy, age 16 years, to Said in 1979 by an Indianapolis boy, age 16 years, to

the psychiatrist Dr Charles Figley:the psychiatrist Dr Charles Figley:

““I wish my dad had been killed in Vietnam. My friend’s I wish my dad had been killed in Vietnam. My friend’s

dad was killed and he came home in a body-bag, but dad was killed and he came home in a body-bag, but

he came home a hero. My dad came back but he is so he came home a hero. My dad came back but he is so

different . He’s a bastard. We can’t live with him”.different . He’s a bastard. We can’t live with him”.

Children’s Reactions to Trauma 1.Children’s Reactions to Trauma 1.

Effects will depend on age and development.Effects will depend on age and development.

1.1.““Infection by association”.Infection by association”.

Hearing, seeing and feeling reactions. Holocaust Hearing, seeing and feeling reactions. Holocaust

survivors.survivors.

Listening to stories and descriptions of the traumatic event.Listening to stories and descriptions of the traumatic event.

2.2. Changes in behaviour. Changes in behaviour. At School and Home.At School and Home.

Fear. Confusion. Anger. Violence. Disruption.Fear. Confusion. Anger. Violence. Disruption.

Sleeplessness. Dreams and Nightmares. Bed wetting. Sleeplessness. Dreams and Nightmares. Bed wetting.

Thumb sucking. Depression. Sensitivity to criticism. Thumb sucking. Depression. Sensitivity to criticism.

Crying. Tantrums. Withdrawal. Rejecting affection. Crying. Tantrums. Withdrawal. Rejecting affection.

Being uncooperative. Demanding affection. Clinging.Being uncooperative. Demanding affection. Clinging.

Children’s Reactions to Trauma 2.Children’s Reactions to Trauma 2.

3.3.Acting out through play. Acting out through play. (They don’t have the words).(They don’t have the words).

Bullying. Aggression. Disruptive behaviour. Playing Bullying. Aggression. Disruptive behaviour. Playing

alone.alone.

Drawings, paintings and play can express hidden emotions.Drawings, paintings and play can express hidden emotions.

4.4.Blaming self.Blaming self.

““It’s my fault”. “I’m bad”. “Nobody loves or can love It’s my fault”. “I’m bad”. “Nobody loves or can love

me”.me”.

5.5.Physical illnessPhysical illness..

Generally feeling unwell. Headaches. Tummy Generally feeling unwell. Headaches. Tummy

aches. Various pains! Psychosomatic reactions.aches. Various pains! Psychosomatic reactions.

Children’s needs often ignored. “Children are not affected!”.Children’s needs often ignored. “Children are not affected!”.

Possible Reactions & Effects.Possible Reactions & Effects.

PhysicalPhysical and and Psychological Psychological reactions can have a reactions can have a

devastating effect on the quality of life of individuals and on devastating effect on the quality of life of individuals and on

those who live or work with them.those who live or work with them.

There will also be There will also be Social Social effects and reactions from those effects and reactions from those

around them including partners, family, friends, neighbours around them including partners, family, friends, neighbours

and work colleagues.and work colleagues.

These These inter-relatedinter-related reactions can destroy relationships, reactions can destroy relationships,

family life and the ability of those involved to maintain and family life and the ability of those involved to maintain and

sustain a positive, happy and successful life.sustain a positive, happy and successful life.

Positive Effects?Positive Effects?

(a) (a) Increased Sense of Value.Increased Sense of Value.

Life becomes more precious with increased feelings of purpose and Life becomes more precious with increased feelings of purpose and meaning. Ability to empathise with others. A sense of peace and meaning. Ability to empathise with others. A sense of peace and satisfaction. Previous anxieties pale into insignificance.satisfaction. Previous anxieties pale into insignificance.

(b) (b) Deeper Appreciation of Life.Deeper Appreciation of Life.

Valuing life, self and loved-ones more. Mutual support in families Valuing life, self and loved-ones more. Mutual support in families and relationships. People and work become more meaningful.and relationships. People and work become more meaningful.

(c) (c) Sense of Achievement.Sense of Achievement.

Increase in personal resources - discovering inner strengths and a Increase in personal resources - discovering inner strengths and a rise in confidence in self and in others. Sense of achievement. rise in confidence in self and in others. Sense of achievement.

““It’s good to be alive”. “I’m a survivor – not a victim!”It’s good to be alive”. “I’m a survivor – not a victim!”

““Those who suffer can feel neglected, abandoned, Those who suffer can feel neglected, abandoned,

misunderstood and rejected by Society at large, but, especially misunderstood and rejected by Society at large, but, especially

for ex-Service personnel, by the organisation to which they for ex-Service personnel, by the organisation to which they

have, literally, dedicated their service and their lives. What they have, literally, dedicated their service and their lives. What they

seek is the dignity of recognition of their plight and appropriate seek is the dignity of recognition of their plight and appropriate

treatment and help - preferably in a military environment”.treatment and help - preferably in a military environment”.

Frank Parkinson.Frank Parkinson.

Any Questions or Comments? Any Questions or Comments?

Especially from your own Especially from your own

Experiences.Experiences.

P.T.S.D. SYMPTOMS P.T.S.D. SYMPTOMS (can also be found in P.T.S.).(can also be found in P.T.S.).

1. RE – EXPERIENCING1. RE – EXPERIENCING.. The Intrusive symptoms.The Intrusive symptoms.

Flash-backs. Dreams & Nightmares. Re-living the Flash-backs. Dreams & Nightmares. Re-living the experience. Recollections of the event. Distress at exposure to experience. Recollections of the event. Distress at exposure to reminders. Re-experiencing sensory impressions. Talking reminders. Re-experiencing sensory impressions. Talking about the event.about the event.

2. AVOIDANCE BEHAVIOUR2. AVOIDANCE BEHAVIOUR..

Avoiding places, people, memories associated with event. Avoiding places, people, memories associated with event. Not talking about the experience. Isolation from others. Inability to Not talking about the experience. Isolation from others. Inability to recall major aspects of the event. Disinterest in family, work, life in recall major aspects of the event. Disinterest in family, work, life in general. Inability to express affection. Little sense of a future.general. Inability to express affection. Little sense of a future.

3. AROUSAL.3. AROUSAL.

Difficulty sleeping. Staying asleep. Difficulty concentrating. Difficulty sleeping. Staying asleep. Difficulty concentrating. Irritability. Outbursts of anger or violence. Hyper-vigilance.Irritability. Outbursts of anger or violence. Hyper-vigilance. Exaggerated startle response.Exaggerated startle response.

Trauma Support – General Trauma Support – General Aims.Aims.1.1. INTEGRATION INTEGRATION - - to encourage the process.to encourage the process.

2.2. NORMALISENORMALISE - - reactions to the event.reactions to the event.

3.3. TALKTALK – – to allow people to talk about any reactions.to allow people to talk about any reactions.

4.4. UNDERSTANDINGUNDERSTANDING - the event and any reactions. - the event and any reactions.

5.5. RESTORERESTORE - - group or individual confidence /solidarity.group or individual confidence /solidarity.

6.6. INFORMATIONINFORMATION – – to give information about:to give information about:

Possible Reactions – during and after the event - and now.Possible Reactions – during and after the event - and now. The need for ongoing monitoring - of self and others.The need for ongoing monitoring - of self and others. When and how to seek help – the 4 week rule.When and how to seek help – the 4 week rule. Internal & External Resources available for support & referral.Internal & External Resources available for support & referral.

7.7. To respond to the ‘Duty to Care’.To respond to the ‘Duty to Care’.

Brain Research.Brain Research.

The ‘Limbic System’The ‘Limbic System’ -- Research into the workings of the brain Research into the workings of the brain suggest that in P.T.S.D. there are changes in the way the brain suggest that in P.T.S.D. there are changes in the way the brain processes information. The Limbic System is responsible for processes information. The Limbic System is responsible for managing the managing the autonomic nervous system autonomic nervous system and reactions to events, and reactions to events, especially in face of threat.especially in face of threat.

The AmygdalaThe Amygdala - is the body’s early warning and alarm system - is the body’s early warning and alarm system which releases hormones, such as cortisol, leading to the ‘Fight, which releases hormones, such as cortisol, leading to the ‘Fight, Freeze or Flight’ response. Hormones can be released into the Freeze or Flight’ response. Hormones can be released into the system even when there is no threat.system even when there is no threat.

The HippocampusThe Hippocampus - - helps to process information and, under helps to process information and, under certain conditions, can lose its ability to function correctly.certain conditions, can lose its ability to function correctly.

The Hypothalamus The Hypothalamus - exerts control of the ‘Sympathetic Nervous - exerts control of the ‘Sympathetic Nervous System’ - body temperature, glucose levels in the blood and System’ - body temperature, glucose levels in the blood and might be involved in regulating sleep, sexual desire and mood. It might be involved in regulating sleep, sexual desire and mood. It indirectly controls the pituitary and thyroid glands.indirectly controls the pituitary and thyroid glands.

P.T.S.D. Treatment – General.P.T.S.D. Treatment – General. Psychotherapy.Psychotherapy. Cognitive-Behavioural- Therapy (C.B.T.).Cognitive-Behavioural- Therapy (C.B.T.). Psychodynamic counsellingPsychodynamic counselling Group / Individual Counselling or Therapy.Group / Individual Counselling or Therapy. Family Therapy and Support. Family Therapy and Support. Education and Giving Information.Education and Giving Information. Medication and drugs.Medication and drugs. Relaxation. Exercise. Massage.Relaxation. Exercise. Massage. Drawings. Painting. Collages. Music.Drawings. Painting. Collages. Music. Eye Movement Desensitising and Reprocessing.Eye Movement Desensitising and Reprocessing. Imaging Techniques.Imaging Techniques. Tape-Recording/writing stories – listening to/reading the story.Tape-Recording/writing stories – listening to/reading the story. Flooding - Expressing Emotions - Exercise - Diet.Flooding - Expressing Emotions - Exercise - Diet. Exposure Therapy. Systematic Desensitisation. Flooding.Exposure Therapy. Systematic Desensitisation. Flooding. Talking techniques - Defusing & Debriefing.Talking techniques - Defusing & Debriefing. Use of cultural rituals - Indian Smoke Lodge (USA).Use of cultural rituals - Indian Smoke Lodge (USA). Religious rituals. Reunions. Memorial services.Religious rituals. Reunions. Memorial services.