Introduction
Trauma can be defined as the mechanical damage experienced in the body and which is a result of an external force. A patient that experiences trauma is therefore characterized as an individual in need of treatment and timely diagnosis of the potential injuries through a team of health professionals. The multidisciplinary team involved is supported by resources so as to eradicate the risk of contacting permanent disability or even death. The analysis below is going to provide an overview of the concepts of trauma and resilience (Wilson et al 2007). It will also bring to the fore the impact that trauma can have on peace making activities as well as we can make peace through understanding issues related to trauma.
Research indicates that Trauma is the third leading cause of death in the United States. Patients between ages 1 and 44 are known to die as a result of trauma related incidents. In understanding the concepts of trauma, we can be well positioned to appreciate what a patient is growing through. Furthermore, other survivors of trauma take quite a long time to heal in the society. People take a long time before they can fully recover from trauma, and this is known to have a negative impact to the success of the society (Elworthy et al 2006). Trauma is an experience which can be emotionally painful for those who under go it.
It’s imperative to note that trauma can result in lasting mental as well as physical effects. Furthermore, trauma is characterized by an event which can be at times repetitive and a response or reaction that involves an overwhelming experience of being powerless and helpless (Connor 2006). AS will be discussed below, traumatic event can eventually lead an individual to experience a complex post traumatic stress disorder also known as (PTSD). Research further indicates that recent acute traumatic event is most likely to result in simple PTSD.
Concepts of Trauma
Trauma, as have been outlined above, is an experience of personal violation on personal safety on a person close. If an individual experiences trauma, he or she may lead to a continued emotional, psychological, physical as well as spiritual impacts on an individual and in the long term, their relationship. Post Traumatic Stress disorders results when the symptoms take tale after a period of experiencing stress (Baldwin 2011). It is important to understand that trauma can occur to good people as well as those who claim to be competent. Furthermore, people who have good health can also experience traumatic stress. Several people are known to experience both the short term as well as long lasting problems which is as a result to exposure to trauma. A person may be in a position of becoming less fearful when they understand the symptoms associated with trauma (Feliciano et al 2008). People develop Post Traumatic Stress Disorder (PTSD) if they have been exposed to severe traumatic situation.
Classification
PTSD can be classified as a kind of disorder resulting from anxiety. The person can be prevailed upon by aversive anxiety-related experiences, physiological responses as well as behaviors that are generated after exposure to a psychologically traumatic experience. The symptoms associated with trauma can be adaptive, and one can be able to recognize it through its evolution and hence one can be able to avoid a disastrous outcome. It is true, however, that not everyone who undergoes traumatic experience can be poised to develop PTSD (Lederach 2002). Some of the traumas experienced may be as a result of betrayal, fear and may to a great extent involve feelings relating to helplessness. When one experiences trauma as a result of betrayal, a situation of psychogenic amnesia may develop.
PTSD Symptoms
Post traumatic Stress Disorder is basically the most common diagnostic category employed so as to evaluate the symptoms uplifted from emotionally traumatic experience. The disorder is characterized by an event that has been triggered by death threats or an incurred injury and as a result, fear, horror and a state of helplessness was realized (Prince et al 2004). A diagnostic criterion should be carried out if the symptoms of fear, horror and helplessness continue to persist for more than a month after the incident.
There are three main dimensions realized in PTSD as the symptoms are taken into account. They include Avoidance in which case the patient tries to minimize exposure to things and close members that may generate their intrusive symptoms. Intrusion is the second symptoms noted and includes nightmares or flashback where the traumatic event is called back to mind. The third symptom includes Hyperarousal where there might be increased arousal like increased startle and hyper vigilance (Van der Kolk 1987). The criterion associated with majority of Americans can be depicted in the Diagnostic as well as statistical manual of mental disorders or the DSM.
Physical reactions to trauma might include:
- An individual may feel agitated as well as constantly on the look out for impending danger.
- One experiences some trouble when trying to fall or even stay asleep.
- Loud noises are known to sound as a bother and even an intrusion from behind will adversely affect the person.
- An individual also feels shaky as well as sweating.
- Complications may be witnessed when breathing.
Cognitive reactions to trauma comprises of:
- One is able to recall the trauma through simple events and occurrence.
- An individual develops an upsetting memory and night mares like images or thoughts about the trauma.
- There is trouble when one tries to think or even concentrate clearly.
- It proves difficult for an individual to concentrate in normal tasks that requires utmost focus.
- One does not think about anything else other than the traumatic experience.
Emotional reaction to trauma might also include:
- One gets upset when he or she is reminded about the events of the trauma.
- There is the feeling whereby one feels as being in danger again.
- One develops anger as well as aggressive feelings and one feels as though they might be in danger once again (Vartuli et al 2011).
- The individual concerned develops trouble as far as controlling the emotions are concerned.
- One can now assert that he or she is going crazy.
- There are flashbacks reminding the person about the trauma and it can sound vividly as though it was happening at the place.
The Cost of Trauma
The impact seen as a result of experiencing a traumatic event can be both pervasive as well as being destructive to the lives of individuals lives, communities, their respective families and by large the nation. We cannot be in a position to fully estimate the valued cost in unresolved trauma to the society (Paulson 2009). Trauma on the other hand has been characterized with physical as well as mental illness, learning, disabilities and even religious intolerance and violence in individuals and the nation.
Psychological trauma: PTSD can be stated as being caused by physical trauma or the psychological trauma, and in most cases, can be a combination of the two elements. PTSD can further be caused by individuals in incidents like rape cases, terrorist attack or war. Sources of trauma can be attributed by observing an assault during the childhood days or even an adult experience of sexual assault (Burg 2008). The symptoms related to PTSD may thrive in an environment experiencing violent assault, sexual assault, torture, hostage, and violent automobile accident or one being informed that you have to undergo a life threatening diagnosis. Children on the other hand may be subjected to PTSD symptoms as a result of bullying or mobbing. The diagram below shows a perfect example of an individual undergoing eth cruelty of the police force (Brown et al 2006). This is an act that remains vivid in the minds of several people.
Neuroendocrinology: Symptoms depicted by PTSD can be as a result of traumatic events which eventually causes an over active response of the adrenaline. The response later causes deep neurological patterns in the functioning of the brain. Neurological patterns can on the other hand last for sometime after the incident has passed on and the individual can be left hyper responsive to fearful situations in the future (Connor 2006). PTSD is characterized by biochemical changes in the brain as well as the body which are different from other psychiatric disorders like major depression. Dexamethasone suppression test response can be stronger in individuals who have been diagnosed with PTSD unlike in those who have been diagnosed with clinical depression.
Furthermore, individuals who have PTSD depict a low secretion of cortisol as well as high secretion of catecholamines in the urine. The ratio of cortisol/norepinephrine is higher than comparable to individual who are non-diagnosed. There is low level of Brain catecholamine and high concentration of corticotrophin relating factor (CRF). The evaluation above suggests abnormality in the hypothalamic pituitary adrenal (HPA) axis (Caruth 1995). Consequently, abnormalities can be noted on strong negative feedback as a result of the strong cortisol suppression to dexamethasone.
Neuroanatomy: PTSD may give rise to the alteration of three parts of the brain. This includes the prefrontal cortex, amygdale as well as the hippocampus. In human studies, the amygdale is known to be strongly associated with the formation of emotional memories and more so the fear related memories (Flint et al 2007). The amygdalocentric model relating PTSD suggests its association with the hyperarousal of the amygdale and insufficient top down control by the medical prefrontal cortex as well as the hippocampus and more so during the process of extinction.
Diagnosis of PTSD
Exposure to a traumatic event: It is vital to have exposure so as to have a loss of physical integrity or can even risk a death penalty to an individual or to other people. It should also act as a response to a given event that aroused fear and state of helplessness in a person.
Persistent re-experiencing: For instance, flashback memories must be present in a victim who might be characterized with recurring distressing dreams, subjective of the traumatic events or even intense negative psychological response to a given subject of the apparent event order.
Persistent avoidance and emotional numbing: In this sector, there is avoidance of stimuli which can be linked to the trauma which envisions the feelings and thoughts, narrating on the events. It also entails avoiding certain behaviors, places, or people who might lead to distressing recall of the memories (Garland 2000). Furthermore, it is christened with inability of recalling major events that occurred in trauma or the limited participation in fundamental activities of life.
Consequently, Trauma is treatable and at the same time preventable. The society should initiate a project that aims at creating awareness and the effective treatment should be fundamental to the societal undertakings. Furthermore, Trauma is a psycho-biological event as it impacts on the body and deserves to be treated at all the given levels.
Assessment of Resilience in the Aftermath of Trauma
The symptoms associated with post traumatic stress disorder (PTSD) are known to account for considerable morbidity as well as mortality. It is therefore important to deploy tools that will assess various components of the situation. This is the basis upon which it is inevitable to avoid psychological resilience. Resilience is therefore a fundamental factor deployed towards assessing healthy as well as pathological adjustment after a traumatic experience (Henderson 2009). Stress coping ability can therefore be termed as the resilience exercise. In this situation, it is important to evaluate personal qualities which allow individuals as well as the society to grow and record positive trend in the wake of adversity.
There are different characteristics that are associated with resilience and which includes internal locus of control, strong sense of commitment to self, a sense of meaningfulness, the ability to view changes and stress as a challenge and engaging the support of others. It also involves securing attachment to others, collective or even personal objectives, self efficacy, sense of humor, strong self esteem, action oriented approach and the ability to strengthen effect of stress. Resilience also leads to the development of patience, tolerance to negative affect, faith and optimism (ITHI 2004). However, resilience is a trend that gradually develops with the lapse of time. For instance, people with a greater hardiness also exhibit an internal locus of control. It is also important to note that several resilient individuals assert that stress can have a strengthening effect and so they will be ready to quickly adopt to change. Individuals in resilience employ positive emotions so as to recover from the negative emotional experiences. In examining resilience in trauma, we ought to look into the strengths as well as positive attributes rather than on the weakness realized (McGrath 2009). These may hence encourage an individual in undertaking more adaptive undertakings.
Measuring Resilience in Patients with PTSD
In analysis of responses posed with trauma, it is imperative to include the study of resilience as well as health. The CD-RISC can therefore be used in measuring various aspects related to resilience in patients as well as with the PTSD. Furthermore, the Stress Vulnerability Scale (SVS) is used in measuring the degree of perceived distress aligning with the daily stress or setbacks (Wilson et al 2007). The CD-RISC and SVS are not difficult in their usage and can even be used to individuals who are not faced with specialized mental health training for they can be taught to administer the self rated scales in the field.
The CD-RISC is a brief, self rated questionnaire which is used to quantify resilience hence establishes reference values as well as evaluating the clinical effects of pharmacologic treatment on resilience. The diagram below shows the effects of pharmacotheraphy plus the CBT on resilience in US patients with posttraumatic stress disorder.
(Elworthy et al 2006)
The main objective in treating patients with PTSD is to alleviate the fundamental symptoms of the disorders, stabilize resilience, improve the normal functioning and in the long run achieve remission. An individual can be able to cope with prevailing stress while at the same time adapt in the aftermath of the tragic event. Resilience can therefore be considered as an important part for mental health (Feliciano et al 2008). It is however not easy to evaluate the concepts of resilience due to the fact that it can’t be reduced to any one single construct.
Hardiness: The personality trait of hardiness in an individual helps to buffer exposure to emerging stress. Hardiness can be seen as comprising three major dimensions which are being committed in finding happiness in life, the notion that an individual has the power to positively influence the environment within which one is and the subsequent outcomes of the event. Based on the description given above, one notes that hardy individuals have been able to appraise potentially stressful situation as being les threatening (Caruth 1995). They are therefore likely to minimize the occurrence of distress; they are also more confident and better equipped in using active coping as well as the social support. The elements help them be able to tackle distress that comes along their way.
Self Enhancement: This is another dimension which can be linked to resilience in trauma. At the of formalizing the PTSD, social psychologists had begun challenging the traditional assumption that mental health entails realistic acceptance of personal limitations as well as negative characteristics. Self enhancement had proved vital for individuals who have been bereaved and who are suffering from severe losses. Self Enhancers are characterized by being able to adjust properly and they have well and active social networks (Lederach 1997). They are therefore rated as being more positive and can be adjusted by their closest friends.
Repressive Coping: Resilience to trauma has been reported among the repressive coopers. Research has indicated that the given type of people tend to avoid an environment of unpleasant thoughts, emotions and memories. Repressive coping appears to be operating through their emotions focused mechanism like the emotional dissociation. Emotional dissociation can be described as being maladaptive and can be linked with long term health costs (Henderson, 2009). The same characteristics may also be associated with fostering adaptation to extreme adversity.
Positive Emotion and Laughter: One of the methods through which repressors and others tend to cope in eth face of adversity is through the deportment of positive emotion and thought. Being in possession of positive emotions may entails one to minimize the levels of distress following aversive events as a result of quieting or even undoing the negative emotions. People who show genuine laughs and smiles at being bereaved can be well positioned to adjust over several years of bereavement.
Impact of Trauma
Depression: Sorrow and grief are normal encounter after an experience related to trauma. Furthermore, people are known to develop negative thoughts about themselves. This shows how it may not be easy to negotiate for peace when an individual has no inner peace and harbors negative thought about other people as well as the world in general. The feelings and thoughts are known to be boosted as a result of people getting oriented to the traumatic experience. People are different the world over and others may have the feeling of trauma persist for a long time and hence they cannot be well placed to participate in the peace making process (Brown et al 2006). These people tend to reflect back on the incident and hence affect their level of participation and association.
These people will in the long run develop an environment where they feel oppressed and are deeply depressed. It is advisable that they be subjected to a doctor or a health practitioner so as to receive some help. The signs depicted as a result of depression are little or no interest in pleasure and normal activities. The individuals are at times tearful, they feel low and miserable, tired all the time, they experience changes in their appetite, sleep or weight, and they feel worthless, helpless and hopeless. To a larger extent, they harbor suicidal thoughts in them as well as having poor concentration (Spiers 2002). It is therefore important to state that such an environment with the above named factors may not be easy to negotiate for peace making activities.
Depression is known to be a hindrance and developing daily activities. One will be restricted on seeing friends, going to work and even getting out of bed. As a result carrying out these activities may prove costly to them and also difficult to undertake. Depression will also be an obstacle for people wishing to get through their traumatic experience. In order to improve peace making process, we can assign the victim to a mental health professional who will journey with him or her so as to enable them come back to their senses.
Anxiety: Several people are known to experience anxiety and fear during the time of traumatic event and even after the perceived incident. Individuals in such a scenario may be characterized by the feeling of being stressed up, on edge and even terrified. It will therefore not be easy to negotiate for peace when people feel disoriented and look at things as being unreal. People who have these given disorders experience a racing heart, sweating, shaking, trembling and dizziness while others feel nausea and the feeling of nausea (Paulson 2009). The affected persons are also going to experience some difficulty in breathing.
Risky alcohol and drug use: In order to get rid of the emotional pain as a result of the distress, people tend to use alcohol and drugs. Individuals view that consumption of alcohol as well as drugs may assist in blocking out the painful memories in the short term basis not knowing that they are interfering with the recovery process.
Difficulties with relationship, work and daily life: Traumatic events can lead to mental health problems which can have a significant impact on the family, social as well as work life. The distress realized is likely going to affect the way in which people interact with others. The situation can be seen as taking different forms like the withdrawal from social and family activities. Individuals are also seen as being poised with difficulties to express their emotions. It will not be easy trying to control people who have anger and can give rise to serious as well as negative consequences (Vartuli et al 2011). Reporting back to work may also not be quite easy to someone who has just been through a traumatic event. It can also be attributed by calling the help of a medical practitioner so as to provide information on where they can get practical support and rehabilitation if there is need for that.
Trauma impacts directly upon the victims of terror as well as their families and friends. But the viewers of televised terror are also vulnerable to secondhand trauma; For instance, there is a cumulative stress from the on and off experience to the attack by the terrorist attacks that influences the collective nervous system of a being. Traumatic environment have also the characteristic of awakening old traumas and activating dormant symptoms (Burg 2008). The effects of trauma are often not immediately apparent.
Trauma and Peace Building
One of the ways that has emerged with an aim of preventing and responding to the conflicts brought about by trauma is peace building. Peace making can hence be characterized by the process that drives the establishment of long lasting peace as well as trying to prevent the recurrence of violence (Bonano 2004). This is done through efforts that tackle the exact cause of violence in the society and its effects by reconciliation, institution building, economic and political transformation.
Peace making activities that are deployed after trauma can be broken down into two main types. The first one is intended to make focus on the structural sources of conflict, in this case focuses on the governmental and economic institutions and their reformation. The second part of the peace activities deals with improving the relations between groups that are community based (Connor 2006). Trauma may have an impact on peace building activity in several ways. Some of these ways may include the following:
- Individuals having undergone trauma, will feel so wounded and they tend to have mistrust of people in a general perspective. They feel that it is not important to try and bring them together once more. The situation leaves the victims with too much isolation and loneliness. This may impact negatively in trying to bring about peace initiatives in the society.
- In carrying out the need for reconciliation, people who have undergone trauma tend to see themselves as inferior to the rest. In doing so, they develop fear that there is something bad about them and they look at this aspect as going to harm someone else they interact with.
- A great level of dissociation offers the victims of trauma the inability to assess potential friends and romantic partners. This is an indication that most people are going to hold back critical information that may be needed to advance on the peace initiative and bridging.
- Trauma tends to cause sabotage in relationships. Despite the fact that peace making is intended to bring people together, most cases end up by separating couples who have been married for quite some time (Prince et al 2006). For instance, a man or woman may get angry at the other and they become violent and abusive making the peace process hard to achieve.
- Due to loneliness experienced during trauma, one finds himself being involved in abusive relationship. This relation may involve friends, romantic partners or even people who have been destine to offer assistance.
- There is a premature attaching to other people. One can be tempted to disclose sensitive part of their information to others before they can have them as friends. This tends to leave the people broken when an argument arises for the sensitive information may be brought to the public domain.
In recent times, professionals have started evaluating concepts involving trauma and conflict. When someone is narrating the incident to a person intended to help, the helper may turn out to be affected. This is termed as the secondary victimization. The person advocating for peace will be influenced by the traumatic nature of the violence and they can be mentally affected by the true scene being mentioned by witnesses. This shows that the peace effort may not come to completion for the hunter may as well turn out to be the hunted in this case, and will derail the peace process (Spiers 2002). Many societies are subjected to traumatic events but not all of the members are affected by PTSD. Peace making initiative is based on the concept of conflict sensitive environment. For those who have undergone trauma, trying to bridge the gap through peace building may not be effective. Consequently, other people still view their relationship as the chance of their being involved in rape or even murder.
Trauma as improving Peace Making Process
People who have undergone the experience of trauma are well placed to make peace building exercise a success. Some of those who have undergone the ordeal should avoid going to the extremes. Others try to understand that isolation from the rest is likely to yield a positive outcome. Learning to share off with peoples is a positive experience that can boost the peace exercise (Elworthy 2006). Victims should also learn to pay attention to what the inner voice is suggesting. The suggestive voices should not hinder us from associating; on the contrary, they should act as our guiding stone so as not to make mistakes again.
Getting to know one is an experience which can also help an individual to analyze peace initiative. The peace process will be uplifted by an individual getting to understand the parts of his or her body. Sharing information about the people you are getting close to enables someone to build an effective environment for association. By taking care of ones health, one can be able to cope with stress. Coping with aftermath stress enables individuals to take care of themselves through exercise and hence can be able to follow the proceedings of peace making (Feliciano 2008). In order for the victims to be supported, they ought to understand that they have to remain understanding to the whole exercise of peace making.
Strengthening the Traumatized Population
In the case of adults, group work is considered by many as an effective way to strengthen the traumatized population. Most adolescents feel more comfortable when they spend most of their time in groups for they are more comfortable with the peers other than the adults. The group therefore offers an opportunity for the restoration as well as a caring family. The groups are known to consist of understanding peers and emphatic adults. The groups therefore enable the adolescents a supportive group of people who are ready to accompany them in the process of hard times without feeling left alone (Wilson 2007). They are able to freely share the experiences of their ordeal through narrations, an indication that they are opened up and lessened of the pain. The aim of group work also enables victims to interact with their peers hence avoiding withdrawal from others. Group initiatives assist adults to limit arrest of positive development in their lives.
Group activities open an individual to more security and as a result, enable the individual to develop an upright posture and individuation characteristics. Group work therefore enables an individual from trauma to develop a peer relationship. The traumatized find a peaceful environment which facilitates positive growth and the discerning of emotional growth. The group experience opens avenues for sharing through other members who have undergone such experiences. For instance, people who have lost their relatives and friends are able to interact with others who have lost their loved ones through bomb blast or even the 9/11 attack (Prince et al 2004).
In an individual point of view, victims of traumatic experience are able to apologize for their past wrongs and should be sincere from their hearts. A person who feels uncomfortable sharing with other people can as well undertake a personal reflection.
An individual can build on resilience through developing supportive as well a caring relationship at home and among the friends. An individual should therefore accept help as well as effective support and they can be in a position to help other heal from the same incidents. At times it may be hard to accept controlling situations that are beyond the victim’s control. For instance, an individual have to accept the concept that we can’t change everything. An individual should accept the situation and move forward determine not to experience the same heartfelt situation (Vartuli et al 2011). Furthermore accepting change as the constant thing in nature can help strengthen the victims of traumatic conditions. Setting realistic goals is the other concepts that assist individual yearn for positive growth and put trauma behind them.
Sporting activities is the other factor that can uplift an individual to develop a positive view about others and themselves. If an individual was best at football, he or she should be confident towards evaluating their strengths and abilities. In some instances, it is vital for victims to maintain a state of being hopeful and optimistic (Prince et al 2004). Persons ought to look unto their physical and mental health through relaxation and peaceful activities. This brings in the strength as well as balance so as to deal with a difficult decision.
Effective Therapy versus Symptomatic Treatment
In order to ensure that effective therapy has taken place, we ought to realize the characteristic of trauma itself. This will also assist in learning more on how to bring peaceful coexistence between an individual and the community. It is therefore fundamental to accord people who have been subjected to traumatic condition like abuse and even brutalization to have their way out. In order to cultivate an environment of effective healing, one will have to own up their feelings and embrace the self status (Roxworthy 2008). One cannot be able to cultivate peace with the community without first getting to understand himself or herself.
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