When most people hear the word â€œtraumaâ€ they understandably think about combat veterans and Post-Traumatic Stress Disorder. But traumatic events are not confined to the battle field. They include being involved in an accident, being the victim of crime, surviving an earthquake or other disaster, or even witnessing others go through terrible things (e.g., some children were traumatized by news reports of Christina Taylor-Greenâ€™s murder in Tucson). Like the events themselves, immediate reaction to them is very hard to predict, as I know from painful experience.
Many years ago, my wife and I were driving home at night on Highway 101 and saw something that we wish we could forget, but never will. An apparently intoxicated man was walking slowly across the interstate, and the car next to us hit him at full speed, having no chance to stop or swerve when the man suddenly became visible in the headlights. The man was thrown high into the air and landed on the highway, to be immediately run over and killed by the car behind us. I write about this horrific experience now to tell you what you might expect if you ever experience a traumatic shock and how you can help someone else who has been through one.
My wife and I illustrate the extremes. She began screaming as soon as the man was struck and thrown into the air, while I just stared silently, as if I were watching a movie from the very back of the theater. As he was run over a second time, I heard the sound of his head being struck by the bumper and his body being crushed into the pavement by the undercarriage. With windows rolled up and the second impact taking place as we were already past the spot of the first collision, hearing that sickening impact â€“ like the sound a bowling ball makes as it comes out of the return chute and collides with the other balls — would have been impossible, yet in my head I heard it. I turned to face directly forward, gripped the wheel tightly and stared into space, dimly aware that my wife was yelling somewhere in the distance.
Many people react to trauma as my wife did, with an explosion of emotion. But others do what I did: â€œdissociate,â€ a psychological form of self-protection that is experienced as emotional numbness and a detachment from reality (e.g., my auditory hallucination). Debating or judging which is better or more adaptive is pointless as they are instinctive reactions that people canâ€™t easily control, and communicating this fact to people who have been traumatized can help comfort them
I came out of the shock in less than a minute and exited the highway so that we could call for help from a gas station. The 911 operator had already been contacted and had dispatched the highway patrol and an ambulance. Feeling that our effort to help was ineffectual, we were wracked by guilt for not getting the man off the highway ourselves. That trying to carry a body across a dark interstate while dodging 70 mile an hour traffic would have succeeded only in getting ourselves killed did not lessen our sense of failure. My wife felt further guilt because she saw the man before I did, and â€œfailed to warn me in timeâ€. But again, this made no sense because the only person to whom a warning would have mattered was the driver who hit him.
Profound, irrational guilt is an extremely common reaction after a traumatic event. Even people whose families die in natural disasters blame themselves. It sounds like self-torture, but itâ€™s adaptive in the sense that accepting a complete lack of control over life-threatening forces is terrifying, so we blame ourselves for the comfort it brings; it lets us believe that we could have made things turn out differently when actually we were helpless. Irrational guilt is best met not with argument but with empathy, e.g., â€œItâ€™s awful to feel that you didnâ€™t do enough to help someone.â€
When we got home we told a mutual friend what happened at least a dozen times, breathlessly, uncontrollably. We imagined slightly different scenarios â€“ if the man had been walking a little slower, would we have hit him? Would we have killed him? Would we have crashed? It had to be boring to hear it over and over, but rather than interrupt us or say â€œFor Godâ€™s sake I get it already!â€ he largely just kept nodding, listening and letting us go on and on. This was the perfect reaction and a model to emulate if you are ever in his role. Putting a traumatic event into words and a narrative is how many people dissipate fear and regain some sense of control and safety.
One might wonder about the opposite situationâ€”the person who will not talk about what happened. Should you prod and push them to open up? For years this was the dogma of psychological crisis work, but it was subsequently proved to be disastrously wrong-headed. People who were randomly assigned after a serious accident to be debriefed by a trained trauma worker were more likely to suffer long-term psychological trauma than those who were left alone. Rather than force someone to â€œprocess their feelings,â€ let them know you are willing to listen, including listening to them say nothing if thatâ€™s what they need to do.
After hours of repeating the story, we were finally exhausted and went to sleep. And then I saw the man in my headlights and tried to slam on the brakes but they wouldnâ€™t work! I woke up yelling, pumping my right leg furiously. Sleep disturbance and nightmares are another common reaction to trauma. Traumatic events can increase noradrenergic arousal, also known as â€œsympathetic activityâ€. This â€œflight or fightâ€ reaction is directly contrary to what normally occurs during sleep, namely an increase in â€œparasympatheticâ€ activity, essentially your brain telling your body â€œYou are safe now, itâ€™s okay to relaxâ€. According to my colleague David Spiegel, sympathetic arousal interferes with sleep, including REM, with wakenings during REM sleep being more likely. In my own case, these symptoms faded in a few days, but for an unfortunate minority they become chronic.
We compulsively talked about what happened and read every news account to find out more information for the next few days. But as we got into the routines of our lives and nothing else traumatic happened, our basic sense of security in the world rapidly returned (this of course is the advantage soldiers on long tours do not have). Today what happened is still an incredibly vivid memory for both of us (as I wrote this post I noticed that my chest tightened and my breathing became shallow) but we rapidly made a full psychological recovery. The good news is that this is the norm. After 9/11, armies of mental health workers were deployed all over the New York City area, and it turned out that many of them were not needed. The resilience of the human organism is an impressive thing, so you would be rational in being hopeful that your acute reaction will have an endpoint. And you can convey the same optimism to someone you care about who has been traumatized and worries about ever recovering.