By Pulkit Sharma August 2013 Events such as the Uttarakhand floods unleash a blitzkrieg of suffering. Can we provide trauma survivors the help and support they need to return to health and happiness? Pulkit Sharma says how Natural and manmade disasters bring traumatic grief for the survivors. They generate a gamut of negative emotions and questions. Floods, earthquakes, bomb blasts, terrorist attacks, forced migration, sexual assault, tsunamis and communal violence attack the inner world of a person. People who lose their close ones, homes or body parts, struggle with shock, pain, loneliness, emptiness, hopelessness, helplessness and rage. While monetary help, material goods and compensation are essential to cover basic survival needs, long-term rehabilitation requires us to work at an emotional, psychological and spiritual level. A Delhi-based victim who lost a family member in the recent Uttarakhand floods kept on asking the question ‘Why me?’ for several sessions in the psychotherapy session. He was angry with his own self, the government, God and me because no one could give him back what he had lost. As a psychologist I had no answer or reassurance but to feel and be with him in immense pain. Trauma, no matter how severe, can heal provided the victim gets the right kind of emotional support. Emotional understanding and holding is the bedrock of treatment of trauma. In order to heal, the victim needs to remember and feel the trauma in the presence of an empathetic person. If this does not happen then the person suffers from a psychological disorder known as post-traumatic stress disorder (PTSD). The individual is irritable, anxious and restless. He/she shows excessive avoidance behaviors and mentally relives trauma via flashbacks and nightmares. Although there are people who genuinely attempt to help trauma victims, they find it difficult to succeed. This happens because all of us have deep-seated resistances and blind spots that prevent us from working effectively with people in pain. Once we identify and work through these resistances, we can be of immense help to an aggrieved person. Being with the pain Because the traumatic event is intensely shocking, the mind does not register and process it completely. In order to deal with the pain, the mind becomes numb and enters denial. In order to heal, this denial needs to fade away and pain must be experienced. As a result, traumatised people revisit the narrative again and again. Often, the survivor wants to talk at length repeatedly about the traumatic event while we wish them to stop the narrative and move on. This happens mostly because we are scared to feel the pain. A young psychologist who was working with Delhi bomb blast victims of 2008 candidly shared, “There is this old lady who wants me to sit by her side everyday while she keeps on crying. I feel so low, hopeless and anxious because life seems so unpredictable. This could have happened to me. When these thoughts come up I wish to run away or to tell her to think positively.” If we are uncomfortable with pain, the survivor cannot rely on us and ends up feeling that his/her pain is bad and scary. However, once we develop sufficient strength to bear the pain, we are able to provide ample space and support to the person, thus starting the healing process. Handling dependence The issue of dependence often comes up in helping and counselling victims of trauma. All of us carry ‘basic trust’, a sense that the world is a good and just place and we will be taken care of and saved under all adverse circumstances. Trauma tends to erode this basic trust and makes the victim feel extremely vulnerable. The victim is in a desperate need to find and hold on to an anchor. Once we start helping and caring for a wounded person they seem to want more and more of us. They almost wish to form a child-adult bond with the helper. This can cause stress and burn-out in the helper. Making promises that cannot be fulfilled adds to the trauma of the victims. This is when victims feel cheated once again and fall into deep mistrust. It is therefore important for any helper to specify their limits early on in the interaction. This saves the victim from developing unrealistic expectations, and feeling consequent disappointment. Giving time The process of grief is gradual and requires time. Under no circumstances, can it be a quick fix. Many people consider getting back to life quickly as a sign of bravery and well-being. This puts immense pressure on the wounded individuals to be back on track instantly. Sudhir, a victim of communal violence, came to me for psychological treatment as he was severely depressed after undergoing motivational-enhancement treatment for trauma. During the training, he was told that brave people let go of trauma swiftly. Sudhir concluded that because he continued to suffer from various symptoms of post-traumatic stress disorder (PTSD), including flashbacks and anxiety, it proved that he was a loser. He felt ashamed, depressed and his remaining self-confidence was eroded. Once he got the message that it was OK to take time to heal, and that he was already on the road to recovery, he regained his self-confidence and the depressive symptoms went away. Hence, it is important to develop patience in order to help survivors of trauma. One must give them the message that their pain is real, valid, normal and it will take time to heal. They need to be reassured that they are not alone in the healing process and that you, as a helper, will always be by their side. Restructuring negative thoughts Trauma often impacts a person’s deep thought processes and self-concept. Ragi, a victim of sexual assault, started displaying dysfunctional behaviors. She would enter into abusive relationships, go into episodes of binge drinking and would get herself into high risk situations. In her treatment, we discovered that due to the trauma she developed negative dysfunctional self-talk. She often repeated in her mind that she was dirty, bad and unworthy and had no right to happiness. Once she learnt to identify and change dysfunctional thoughts and beliefs, there was a marked improvement. She was encouraged to tell herself, “I’m good and deserve happiness. I had no control over the trauma as I was trapped in a dangerous situation without alternatives.” Paying attention to self-talk and replacing abusive self-talk with empathetic self-dialogue works wonders. Repairing self-esteem Undergoing trauma destroys the person’s self-confidence and positive self-regard. He/she feels ugly, worthless and bad. In order to help the person overcome it, they need to be reminded of their strengths and unique abilities. Amit, a survivor of trauma, shared the way he felt after he regained his self-esteem. He said, “Earlier it was as if I became the trauma. I could not see anything beyond the trauma. I lost touch with my identity. I forgot that I was a son, a spiritual seeker, a successful manager and a loving husband. Now as I have regained that identity I feel very positive and ready to move on.” Survivors of trauma need to be gently reminded that there was and still is much more to their identity than just being a helpless victim. This terminates the state of self-pity they are constantly in and instils confidence to confront the trauma and bounce back. However, this kind of encouragement needs to be genuinely based on your understanding of the person’s self. Spurious and shallow mirroring does more harm than good. Forgiving is a choice Most of us believe that forgiving perpetrators is the final step to recovery from trauma. No doubt if one can understand and forgive the perpetrator, it is a huge spiritual movement. However, forgiving is an individual decision. Further, forgiving comes after a long inner movement when the person has dealt with their pain and rage. It is a matter of personal choice. Some people are able to forgive while others cannot let go. As healers and helpers we need to respect both choices and should not force any one to forgive. Telling someone that they must forgive to move on is placing immense pressure on their fragile self. Although trauma is the most destabilising experience a person can go through, the inner self has the potential to heal and emerge from it. Healing is determined to a large extent by how people around the victim understand and respond to them. Therefore, there is a grave need to develop sensitivity, empathy and insight at a mass level. The emotional, psychological and spiritual aspects of disaster management are often not given their due place in our country. Truckloads of food, clothing and medical aid will remain unutilised if the survivors lose the will to live. We must help them hold on to the will and the hope.
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