The phone rang. It was the Counselling Centre. Could I see a woman who had just had a bad car accident in which a little girl died? The same day someone rang me to say their friends had had an armed robbery the night before and were traumatised. Should they have counselling?
Does a person really need counselling after a trauma?
Let us look at that. Firstly, what is a “trauma”? Basically it is an incident which happens suddenly and unexpectedly, where there is threat of or actual injury or death. People affected are not only the direct participants, but can also be witnesses or people closely connected to the victim or victims. For example, the ambulance crew in rescue situations.
Traumas can arise from natural events – earthquakes and floods for example – or they can be man-made incidents, such as vehicle or industrial accidents, assault, rape and armed robberies.
Secondly, why is a trauma so damaging?
This is because it is so far outside our range of normal activities and experiences and is sudden and unexpected. Because we are not prepared for it, our mind does not know how to deal with the trauma and we feel completely out of control, so it takes time to mentally process the incident. We may know for example that armed robberies are common here in Zimbabwe, but we do not really expect it to happen to us.
In addition, the body has an extreme physical reaction to the trauma– a surge of adrenalin enabling us to “fight or flee.” This is designed to help us in an emergency, but in traumatic events, generally it carries on long after the incident, leaving you in the “flight or fight” state. Furthermore are the intense emotions of fear, horror, anger, panic, helplessness or sadness that are experienced. These factors combined, lead to Post Traumatic Stress. (PTS). Failure to recover from this can lead to a lifelong and debilitating condition known as Post Traumatic Stress Disorder. (PTSD)
What are the symptoms of PTS?
Firstly, are the physical symptoms – trembling, pounding heart, breathlessness, nausea, diarrhoea, nervousness, an inability to concentrate or focus, forgetfulness and irritability.
Then there is another group of symptoms that includes the following: Re-experiencing the trauma, Hyper-arousal and Numbing and Avoidance.
1. Re-experiencing the trauma
Most common are intrusive memories. This is where you keep remembering over and over again, parts of the trauma. It may be the sound of impact and a body flying through the air after an accident, or the sudden sight of a robber appearing in your bedroom. The memories are unwanted and distressing, popping into your mind at random times.
During these times you re-experience the feeling or thoughts you had during the trauma. You spend a lot of time thinking about what happened. Usually, you will ponder “What if…?” What could I have done differently to avoid the incident? This is really your mind’s way of trying to make sense of it all.
You may become angry with the person whom you feel caused the accident – the driver of the other vehicle or your wife who left the back door unlocked, allowing robbers’ access. You may be full of blame and angry with yourself. A husband who was unable to help his wife or children, even though he was tied up, for example, still feels guilty.
Less common and more extreme is what is called a flashback. This is where something – like the loud noise of a car backfiring – triggers the feeling that the incident is happening all over again. You feel exactly as you did at the time and so behave in that way – e.g. diving for cover behind a desk at the loud noise. Flashbacks are very distressing and people fear they are going mad.
Another common symptom is recurring distressing dreams, nightmares, or sleeplessness. Sleep may be disturbed by bad dreams and nightmares as a result of the trauma. You may not dream the exact incident, but there is a scenario where you will feel the same emotions – i.e. fear, powerlessness, horror. You may be reluctant to go to sleep because of these dreams, but it is only your mind dealing with and processing the experience, while your body is resting.
2. Reactions of increased arousal/hyper-arousal
These are closely linked to the adrenalin surge mentioned earlier. There is an increased or exaggerated concern for your own and others safety. Your mind and body still react as if you are in danger, even though you no longer need to maintain this high level of vigilance. You become acutely aware of the potential dangers around you and become extremely vigilant, even when it is not called for. You will be constantly looking around, checking the movements of others, aware of passersby, cars driving behind you, and so on. In the street, you may be constantly on the look out for the perpetrators or possible attackers.
You will demonstrate what is called an “exaggerated startle response”, meaning you become sensitive to stimuli around you and are on edge and jumpy. For example, a door banging may cause you to get a terrible fright. Again, this is your mind and body not realising that the danger is past and still trying to protect you.
3. Numbing and Avoidance.
During numbing the mind closes down emotionally as a protective measure after extreme emotional pain has being suffered. Typically, a trauma victim feels nothing or feels like it was all a dream or that it happened to someone else. The feeling of numbness can last up to several days after the trauma, before it starts to wear off and the real feelings about the trauma surface.
This can be mistaken for a person being cold and uncaring or extremely strong, brave and cool under pressure. Care should be taken by those caring for the victim to be ready for this delayed reaction.
In extreme cases of trauma, the numbing can be permanent.
Avoidance is where the victim avoids any place, activity or situation that reminds them of the trauma. It is common for people to find it difficult to go back to a house or into a room where they were assaulted. Victims of car accidents may find it very difficult to drive again, or use the road where the accident took place. Attempting to do so may bring on symptoms of panic and extreme anxiety, the same emotions they felt at the time.
Most of these symptoms fade with time. However, after a trauma a person is never the same, but usually can pick up the threads of their life and be better and stronger as a result.
Counselling plays a part in helping to alleviate and manage all these symptoms and prevent them developing into full-blown PTSD. So yes, counselling is important for people who have suffered a trauma. Not everyone needs it necessarily and many will recover without it, but I do think all will benefit from it.