For those affected by the Midwest catastrophe: Dr. Estés steps for recovery from shock & trauma

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Sun Jun-15-08 01:47 AM
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For those affected by the Midwest catastrophe: Dr. Estés steps for recovery from shock & trauma

We have you in our thoughts. Those who have lost so much will have a hard time taking solace at this time, but perhaps this protocol from one of my favorite writers might help...BB

By Dr. Clarissa Pinkola Estés

This is a Public Service Post, to release the complete protocol letter I use to train therapists and citizen-helpers to serve in post-trauma recovery at disaster sites. It is addressed to the inner circle of victims, survivors, eye-witnesses, their families, workers, helpers, rescuers, and other affected persons.

I’m a Psychoanalyst and Specialist in Critical Incident and Post Trauma Recovery, who developed psychological recovery protocol for the Armenian earthquake rescue, served at Mexico City earthquake site, and at Columbine High School and community for four years after the massacre. I continue to work with 9-11 survivor families on both coasts.

This letter lists critical time-tested steps for recovery from shock and trauma.

RECOVERY AND NORMAL REACTIONS
TO SUDDEN LOSS, INJURY, AND CATASTROPHE

Dr. Clarissa Pinkola Estés

Each person, depending on their innate physical and emotional constitution, is affected differently by sudden shocks and catastrophic events. Symptoms may differ also. Thus, over a period of time, if you of the inner circle, that is, if you are an eye-witness, a victim, a survivor, or a person who lost a loved one, or had a loved one seriously injured, if you are military, fire fighter, worker, helping professional, law enforcement, rescue worker, citizen rescuer, news gatherer, photographer, or in other close-in relationship, you may find yourself having one or more of the following reactions.

These are normal reactions to sudden shock relating to life and death events, to sudden twists of fate. When one has been involved in a critical incident, the body, mind and heart, and some believe too, that the spirit and soul, are shocked as well. It is shocking to see in full consciousness, in a split second, how close death came into our world, how fast, and often at first, how quietly… This witness is arresting to any human being with a heart and soul. The most time-tested remedies I know from my 37 years of clinical work in post-trauma recovery are outlined following this list of reactions:

Physical Reactions:
o Sleep disturbances including inability to sleep
o Lethargy, such as sleeping too much
o Exhaustion, fatigue
o Changes in appetite, digestive disturbances
o Feeling numb
o Crying
o Desire to comfort and be comforted physically
o Nightmares, night terrors
o Loss of memory
o Trembling, inner or outer
o Nausea
o Heart arrhythmia
o Pain in heart, not an organic disorder, but caused by sorrow
o Aching bones, not an organic disorder but caused by sorrow
o Headache, migraine

Behavioral Reactions:
o Hyperactivity
o Poor concentration
o Refusing to talk
o Talking ‘out of one’s mind’
o Startle reactions while awake or asleep
o Isolating, wanting to be alone.
o Wanting to just sit, or just stare
o Trying to help in any way one can, to the point of exhaustion; not wanting to leave the scene
o Hyper-vigilance, watching, listening, being unable to be at rest

Psychological Reactions:
o Loss of sense of time
o Feeling distraught and helpless
o Feeling that things are not real, as though in a dream
o Inability to recall sequences or retrace all of one’s steps
o Feeling the future has been lost forever
o Desire to comfort and be comforted psychologically
o Feeling one should not cry
o Wanting to scream, or screaming-weeping
o Inability to attach importance to anything but this event
o Flashbacks
o Nightmares
o Intrusive thoughts
o Over-reactions to mild to moderate irritations
o Recurrent dreams
o Horrified Anger
o Broken Heart
o Insecurity about the future
o Feelings of fear
o Feelings of guilt
o Feeling one cannot stop crying
o Unusual reserve, acting as though nothing much occurred
o Blaming of others, individuals, groups, passionate outbursts
o Marked frustration with how long everything takes
o Marked frustration with rescue workers, the bureaucracy, anyone who tries to help
o Marked frustration with any who break promises to help, or who are perceived to not be telling all the truth, or who are perceived to be withholding critical information, or who are giving out platitudes or being condescending
o Ongoing violent fantasies
o Anxiety
o Mild to profound depression
o Amnesia
o Thinking no one can ever understand, no one can ever help.
o Keeping secrets about what one might have known beforehand
o Blaming oneself.
o Deep dread about hearing any more terrible news.
o Aversion to films, movies, anything that depicts catastrophe.

Spiritual reactions
o Desire to comfort and be comforted spiritually
o Questioning God, being angry with God
o Not wanting to hear any spiritual counsel
o Wanting very much to hear spiritual counsel
o Feeling God has abandoned everyone
o Praying non-stop, for self, for others, for everyone

These are normal reactions, and they can be painful. Going through them, trying to pinpoint each or some, and find ease, first things first, is part of the direct healing process. No one can instantly cleanse these thoughts and feelings, though I wish we could, for I know they can tear at heart, mind, soul and spirit.

For some persons, after tragedy, they know immediately what they think and feel. For others who are numbed, they may not know where and how they stand with the events and with themselves for weeks and months afterward. That’s alright. It will come. Being thoughtful and watchful of one’s own processes is a good endeavor. If you can’t quite decide, ask trusted others to help you take steps to help yourself as, and if, needed.

For those close in to the disaster, the numbness you feel is your psyche protecting you, taking away for a time, the profound overwhelm of all that has occurred.

For the first days after such enormous shocks, it may almost feel as though time has stopped. That all is surreal. You may feel as though you are no longer here. As though maybe you are dead or deadened. This is because horror and tragedy throw us into a process and lock us in for a time. For most who have feared deeply, or suddenly lost a beloved person, or a furry relative, or a homeplace, a ‘descent’ is not too strong a word for the process. To many, it feels like a big iron gate has closed behind them and that life will never be the same again.

But, be assured that there is an indirect healing process that is taking place underground at the same time… time passing is the indirect healing partner. As time goes on, there is also blessing news… and that is, that fear and horror and grief are processes that have a beginning, a middle and not exactly an end, but a release from that trapped place where you may have felt burdened relentlessly. Eventually that dwindles and eases. You will daily live and laugh and love life again, more and more … it will happen. Not right this moment. But it will come.

As time goes on, less and less will you be taken backward in time to very briefly, but deeply, feel fearful or grieve anew. Those times will occur with longer and longer spans of time in between. Each episode will be intense, but shorter and shorter. For most of us, we do not ‘get over’ life and death heart-wrenching events. We learn to live with them. We learn to live with the aftermath of memories and/ or irretrievable loss. We learn to live with losses that feel they took meaning of our lives away from us for a time, or that took our souls from us and our desire to live life as well.

But the innate life force is ever sending out strong impulses to live again. The life force is muscular, no matter how weak we feel. It will help us see meaning, and new calling in life sometimes too, as we gradually climb back up to vital and vibrant life in every way. It will come.

Please take up all, or any of the following ways to help yourself and know too, that many many strangers, as well as those close to you, are focusing in this very moment on supporting you over the miles, saying strong and ongoing fresh prayers for your hearts and souls to find their ways and to be made whole again.

ACTIONS TO TAKE FOR RECOVERY

– Within the first 24- 72 hours, do strenuous exercise alternating with relaxation. Continue to move daily thereafter. This will alleviate some of the physical reactions, and give your body a way to discharge additional physical and emotional reactions as they surface in the coming days.

– Keep busy, do not sit and do nothing. Feeling displaced, angry, sad, orphaned, and bewildered are normal reactions. Do not tell yourself that you have lost your mind. You haven’t. But it is as though a huge wind has blown through upsetting all previous order. Order will return. A new order. An order for your life that you decide as you decide it, in your own best interests.

– Talk to people — talk is one of the most healing things you can do. Tell your story as you see it. Although some have learned to keep their most precious thoughts and feelings to themselves, they may not realize that by talking some, or a good deal now, they also give others permission to talk out their thoughts and feelings too… and thus to go that much farther in healing.

– This may be the first time some persons will receive encouragement to speak. It doesn’t matter whether one’s talk is broken or cohesive… telling one’s own story is what matters. People who have been deeply hurt, may tell their stories over and over again, many times before they lose their massive charge of pain.

– Don’t push yourself, but if you can, listen to others’ stories; if you can, reach out for those who are poor in resource, poor in spirit, poor in security, for sometimes giving comfort, words of encouragement, is a way to help healing of both teller and listener as well. There are many ways to listen, including being silent together, including a hand on an arm, an arm around a shoulder, an embrace while the other person just leans quietly or weeps.

– There are too, those inimitable words that the soul understands perfectly, which are not said with voice, but with nods of the head and with the eyes; gentle understanding eyes.

– Don’t allow anyone to push you by insisting, “It’s over now, we have to move on.” In grief and great change, the psyche has entered a sacred place, one of deep learning and transformative process. The news media cycle is not your healing cycle.

–Neither is your drummer anyone who is not very well developed psychologically or spiritually themselves, nor those who become understandably fatigued with the ongoing cycles of grief.

– Instead, listen to yourself and to wise others who have come through ‘a great something’ themselves, and mostly recovered. It is a paradox and an issue of compassion for self and others: To tend to what is wounded til healed, while going on with new life as well. Yes, ‘life goes on,’ as some will say, but the emphasis should be on Life! not on hurrying. A wound to the spirit and psyche is like a wound to the body. It takes time to heal from the bottom layers upward.

– Feelings of loneliness and deep feelings of worry, or longing toward loved ones injured, or now gone, can be partially mediated by being with those who understand from the ground up, that is, other people who have gone the way you are going now. Thought it can seem like this never happened to anyone else and you are alone, there are others in the world, on the internet, at certain groups who know exactly what you are experiencing, and they can be of great comfort. Seek it and take it. It is there for you.

– Each time you tell your story, each time you create a symbolic act, a ritual, each event memorialized, each thoughtful new barrier set to help prevent ever again what tragedy occurred in your world, each time you think back to the disaster in order to analyze and learn something valuable, each time you receive someone’s caring, each time you reach to comfort others, to bless and be blessed, you will be healing yourself. And others.

– Try not to cover up your feelings by withdrawing or by using alcohol or drugs. Talk your feelings out. As many times as you need to. There is no shame or selfishness in this. You have been through alot. Sometimes after a tragedy, some are inclined to try to self-medicate with whatever is close at hand. But this is not a time of negating. The psyche is stronger than most realize. This time, despite the horror that began it, will be a time that will bring much to you, much that will be useful for the rest of your life. For many, it will be a time of complete maturing in unforeseen and good ways.

– Reach out to others. They really do care. Be good to yourself and let others be good to you too. Often, the most healing comes from just allowing others to bless your life anew, and you theirs. I tell the people I meet with who have suffered great tragedies, but who often ask what they can do to help others. I tell them, ‘be kind.’ People who suffer greatly will most often forget all the words that anyone ever said during these first days, but what will remain forever engraved in memory, are the kindnesses others offered during those first few days and weeks. Kindness somehow seems recorded by the body, by the mind, the heart, the soul and the spirit. Sense memory; every part of the person registers kindness.

– Spend time with others. There may be times of reflection and solitude. But, do not isolate yourself. You may also find yourself laughing sometimes, even as you grieve. That is not blasphemy: it is the Life Force trying to surface again.

– Ask other people how they are doing. Remember they may be shy to tell a stranger, or even a friend or relative, of their burden unless they are asked, and often, they may need to be asked more than once in order to gain more of an answer from them than just ‘Fine,’ when in fact, they are somewhat– to a lot– less than fine.

– People can become fatigued from this business of remembering and grieving. Grieving is hard work and as numbness wears off and the psyche delivers back images and impressions of the original traumatic event, it can burn up much energy. Rest, take good care of your body. Feed it decent food. Soothe and energize the body.

– It’s alright to take time out. It is not negligent to not want to listen anymore. It is alright not to read newspapers or watch the news. For now, for a while, or ever. Everyone reaches capacity in the grieving process, in recovering from great shocks. Pay attention to what your body and mind, heart and soul need, and secure it.

– Healing from shock is not a straight line, it is a zig-zag line, sometimes two steps back and three steps forward. Stay with it. There is no one right way or perfect way. There is your way. Trust it. Others may offer ideas too. Consider them, take what you need and leave the rest.

– Take time to think things through carefully if you are approached by persons offering legal help. For persons who are badly injured or for survivors of a family member who died, or those who have lost much, legal support is often required. Be aware that in some instances, involvement in years’ long legal pursuits can thieve freedom to live life again as you please, and instead have one’s highs and lows dictated by how the legal case is progressing each day. Consider carefully. If you need a lawyer, it is likely best to seek your own referrals from trusted friends.

– It is true that some of your friends and relatives may never understand what you, the on scene person, experienced unless they were there too. Sometimes the ones we turn to for support, just can’t give us enough. That’s alright. That’s why there are often survivor groups formed. The people in ‘the inner circle’ understand one another innately.

– If you find at any time that you feel stuck in endless anger, or want to isolate yourself without cease, or have unabated high anxiety, or continue to be hyper-vigilant, have intrusive thoughts, flashbacks, thoughts of hurting yourself or others, nightmares or other sleep distresses, over-reactions to run of the mill events, begin to destroy your most cherished relationships… don’t put it off … seek professional help. It is often one tiny thing that needs to be tightened or loosened; not a total tear-down and rebuild.

– It is not a character flaw nor a failure of selfhood to seek psychological, physical or spiritual assistance. Severe, sudden shocks to the body and mind can throw off chemicological balances in the body. Sometimes the body needs medicine to help to recover the chemical equilibrium that influences sense of self and sense of ease with the world. Talk therapy with a therapist trained in post-trauma recovery is useful to untangle thought processes that often become jammed by prior pressure to respond to too many sudden and strong stimuli all at once.

– Therapy is also a place to speak the thoughts you would prefer not to speak more publicly or to friends or family. It also is a place of learning to create new life as you now wish it to be, with insight and vision. Some choose EMDR, a eye-movement therapy that reduces the anxiety of trauma for many; some choose talk; some analyze dreams, looking for symbols which free them when understood, some take medication, practice meditation, sit satsung, and many use expressive arts to come to terms. Use any and all, as you see fit.

– If you are a parent, help your children by listening, listening. Just because your young, or your young adult children are silent, or just because they laugh or go out with friends or say everything is fine, does not mean they are without need of your special regard. The psyche often splits in two during eye-witness sudden trauma. It is a healthy adaptation. One side goes on functionally, while the other side is drowning in bewilderment, helplessness, a sense of the surreal, or sorrow. Do not hesitate to gain psychological advice and therapy, both for yourself and your child.

– Therapy at its best is educative, teaches about how the mind and behavior and spirit actually work together, or don’t, but can, with a few adjustments and conscious good will. Children look to and often follow the tone their parents take about such matters. Just do your loving best.

– In the ensuing days, find things to do that feel rewarding, meaningful or refreshing. These need not be big things, but events or endeavors to offer some small balances to the tragedy and overwhelm you have been through. It is alright to live fully, even though precious others have been injured or died. In fact, it is exactly right to decide to live fully in honor of those who currently cannot or could not. There is to be no guilt for moments of happiness or celebrations. Moments of happiness are, again, the Life Force erupting in your service.

– When you feel bad, find a person to talk to, and to cry with, to tell of your anger and other helpless feelings. Don’t keep it inside. People wind up taking care of you anyway, even when you go mute. It’s alright to talk, even if it’s not
‘your thing.” There are times of life that have great consequence that are worthy of speaking about. This is one of those times. For your sake. For the sake of others.

– You are vulnerable in these moments; take care to not over-indulge or self-medicate with substances, or other mind-numbing addictions, or trying to lose oneself in unprotected sex.

– If you have spiritual practices, your spiritual beliefs will definitely help you through. Cleave to them in full. For those who have been dispirited by some inhumane religious person long ago, do not hold yourself away from this kind of healing for your spirit now. Instead, consider seeking people of spirit who love the soul; there are many of them in the world, some in organized religions and some who wander freelance in this wide world. Ally with them. They will have special balm for you.

– I would just mention this last, also…. for some it is good to develop a category in one’s mind called something like “God’s business,” for some things will never make sense. Accidents are incomprehensible. Twists of fate often have little ‘fact’ to them. Evil things are by definition insensible. And some things, some events, some outcomes, will forever only be “God’s business.”

– We all wish to be brave and strong in the face of disaster. We all wish to be looked up to for our endurance and our efforts to help others. If you truly care for humanity, be sure to include yourself in their numbers, by giving your own inner feelings and thoughts the voice and the dignity they and you so deeply deserve.

And one last, last thing: worldwide there are men and women who are seasoned and industrial strength pray-ers. We’ve got you on our radar and have already sent in the linebacker angels. We’re asking that you and all your loved ones be kept safe, that you see miracles during this time, and that you be made as whole as possible. We’ll keep the vigil candles lit. That’s our idea of fighting fire with fire. Throughout, please lean on our prayers.

Dr. Clarissa Pinkola Estés

This protocol letter for victims, survivors, helpers, law enforcement, fire-rescue, divers, workers and witnesses to massacre and disaster, “Recovery and Normal Reactions To Sudden Loss, Injury, and Catastrophe”; Copyright ©1970, 1999, 2001, 2006, updated 2007, Clarissa Pinkola Estés, Ph.D., All Rights Reserved, is printed here under Creative Commons License: author grants permission for free distribution under conditions that use be non-commercial, text be used in its entirety, and attributed with author’s name and copyright.