“Given the pervasive effects of trauma …educating oneself on the effects of trauma is not a luxury but rather a necessity for conflict resolution professionals.” (Berceli, 2009)

 

Trauma Studies and Conflict Resolution. Two subjects and areas of study that are anything but light. Yet it is this unavoidable weight, and imperative to engage in situations of brokenness, that roots the important and positive contributions they have to offer. Through exploring these two fields, I have come to recognize many of the ways in which trauma influences and conflict, and vice versa. More importantly, I have come to believe that there are positive benefits to be had through increased interaction, conversation, and sharing of lessons learned between the two fields. It is out of these realizations that the following series of posts flow. It is my sincere hope that they will provide a competent introduction for conflict resolution practitioners to the direct and indirect effects of trauma, as well as be a starting point for further questions and collaboration among practitioners in both fields.

 

Over the next little while, I intend to post on various topics related to aspects of trauma that are of relevance to conflict resolution practitioners. These posts, their insights, and the resources referenced within them, come out of an independent study I recently completed under the guidance of Dr. Craig Zelizer while pursuing my Master of Arts in Conflict Resolution at Georgetown University. Topics to be addressed include:

 

  • Individual vs. Societal Focus in Trauma Healing and Conflict Resolution
  • “Understanding” vs. “Knowing” Trauma
  • The Role of Religion in Trauma Healing
  • Meaning-Making
  • Self-Care and the Role of “Pain”
  • Narratives
  • Non-Traditional Approaches to Trauma Healing

 

To begin, I offer a brief description of trauma and its impact on individuals and societies, as well as the overriding framework within which trauma healing interventions or programs are organized.

 

Trauma

 

In the simplest of terms, trauma can refer to 1) a traumatic event, and 2) the mental and physical suffering brought about by undergoing a traumatic event. Thus to best understand trauma, one address what constitutes a traumatic experience, as well as the various impacts of such an event.

 

Traumatic Events

 

Herman succinctly defines traumatic events as “events that overwhelm the ordinary systems of care that give people a sense of control, connection, and meaning” (Herman 1992, 33). For a more formal and medicalized definition, we turn to the DSM-IV, the American Psychiatric Association’s Diagnostic and Statistics Manual. Here, a person is deemed to have undergone a traumatic experience when confronted with “actual or threatened death or serious injury, or a threat to the physical integrity of self or others” (American Psychiatric Association, 1994). The Comprehensive Textbook of Psychiatry expands this definition, noting that traumatic events are those that produce a feeling “of intense fear, helplessness, loss of control, and threat of annihilation.” (Andreasen, 918-924).

 

Each of the above definitions has its place, and touches upon important aspects of traumatic experiences. The DSM-IV draws attention to the importance of the threat to life and physical integrity to traumatic events. Given the tendency for car accidents, large-scale natural disasters, military combat, or bombings to induce trauma, the emphasis on threat to life and physical integrity is sound. However, Andreasen draws attention to other possible sources of trauma through the phrase “threat of annihilation”.  This phrasing expands the definition, incorporating the importance of loss of control and overwhelming nature that both she and Herman articulate as defining aspects of traumatic events. “Annihilation” turns out to be a central term, used by many authors in the field, because it evokes the recognition that traumatic events often threaten one’s internal (spiritual, mental, or moral) integrity, as well as physical. The intensely traumatic nature of slavery, sexual abuse, or child abuse, testify to this fact.

 

The above definitions emphasize the traumatic nature of a single or discreet event. However, there is also recognition that in addition to singular events that overwhelm one’s ability to cope, series of events or social conditions can also induce trauma (Herman 1995, 87). Here, traumatic experiences could include growing up in constant fear and uncertainty due to oppression or being forced to live on reservations that are far removed from one’s homeland and strip one of their identity. While these experiences often co-exist with threats to one’s life or physical integrity, their ability to induce trauma through repeated occasions of stress and threat should not be overlooked.

 

Impact

 

Due to the profound psychological and physiological changes a traumatic event causes to an individual, suffering can occur not only at the time of the event, but continue long after the experience. Individuals who undergo traumatic experiences can often display heightened levels of anxiety, extreme startle responses, lethargy, depression, lack of ability to trust others, disengagement from social interactions, loss of interest in previously enjoyed activities, and difficulty sleeping among other responses (Wilson, 1995). As each response to trauma is unique to each individual, not all individuals will display all of the above reactions. However, these responses are commonly seen above individuals experiencing all types of trauma. Before going further, it is important to note that although many individuals are exposed to traumatic events, not all develop pathological symptoms or profound suffering. Some may display one or more mild symptoms for a period, as is normal in the course of mourning and healing processes. However, for many individuals who experience traumatic events these symptoms prove to be an impingement upon their health and ability to engage with others of which they are unable to rid themselves.

 

When these symptoms are present to such an extent that they adversely affect one’s health, one can be said to be suffering from post-traumatic stress. Returning to the DSM-IV, post-traumatic stress is defined by three clusters of symptoms: re-experiencing, avoidance, and hyperarousal. (American Psychiatric Association, 1994). Re-experiencing consists of intrusive memories, dreams or reactions that remind one of the original traumatic event. Often times they consist of flashbacks, intrusive nightmares, or intense responses to cues that are associated with the traumatic event. Avoidance, on the other hand, consists of actions that seek to distance oneself from stimuli associated with the trauma. This can often take the form of emotional numbing, avoiding thoughts that remind one of the traumatic event, or lack of feelings of connection with others. Finally, hyperarousal refers to somatic (bodily related) symptoms that are elevated above normal levels. These refer to difficulty sleeping or concentrating, hyper-vigilance, exaggerated startle responses, or angry outbursts.

 

When an individual displays a certain number of symptoms in each category (re-experiencing: 1; avoidance: 3, hyperarousal: 2) they meet the criteria for the diagnosis of a stress-related disorder. When the symptoms are present and impactful for less than 30 days after the traumatic event, the diagnosis is of an Acute Stress Disorder; when the same symptoms persist for longer than 30 days, it is diagnosed as Post-Traumatic Stress Disorder (PTSD).

 

It is easy to see how the impact that these symptoms have, whether diagnosed as a stress-related disorder or present at a subclinical level, is detrimental to those affected. Anxiety, depression, and hype-vigilance exact a heavy toll from one’s health. These symptoms also have a strong impact on the society of those afflicted. This is especially evident when looking at development, peacebuilding, or humanitarian work in conflict zones. Engaging in these efforts requires not only great resolve, effort, and hope, but also engagement with former adversaries, personal sacrifice, and coordination. Looking back to the symptoms of post-traumatic stress, it can be seen how difficult these activities would be for one affected by trauma. A myriad of the above symptoms, and their attendant difficulties, must be overcome to generate local support and leadership for interventions that require a traumatized population’s engagement.

 

Healing

 

“Recovery unfolds in three stages. The central task of the first stage is the establishment of safety. The central task of the second stage is remembrance and mourning. The central task of the third stage is reconnection with ordinary life.  Like any abstract concept, these stages of recovery are a convenient fiction, not to be taken too literally.” (Herman 1992, 155)

 

In the text following the above passage, Herman goes on to explain how these three stages have been represented in a similar manner (though in sometimes compressed or expanded forms) throughout the history of trauma treatment. Starting with Pierre Janet in the late 1800’s to current Cognitive-Behavioral Therapy approaches, those individuals who sought to understand and treat victims of trauma have recognized that the healing process unfolds along a similar pathway (Ibid). While different theories or methods of treatment emphasize different waypoints along this healing journey, taken in their entirety the overarching framework (here articulated by Herman’s three stages) is always present.

 

Stage One: Safety

 

Work in stage one emphasizes the creation of a safe environment, both physically and psychologically. In those who display subclinical symptoms of post-traumatic stress, this is often accomplished through time at home or in another safe and comfortable place with friends or family. When this is not possible, or the symptoms are more severe, one of the primary goals of therapy is to utilize the therapist-client interaction to establish a safe place and relationship. Given the great lengths to which individuals who are suffering from traumatic stress will go to establish and secure safety, this is a foundational part of the healing process. The where and the how often change in this stage, depending on each situation’s unique circumstances, but the emphasis on establishing safety remains the same.

 

Stage Two: Remembrance, Mourning, (and Witnessing)

 

Building upon the establishment of safety, stage two deals with processing the traumatic event and its impact on oneself. In western society, this often entails the telling one’s story to either loved ones, or at others times, a therapist. In other societies, ritual actions and the telling of traditional stories can be present (Thompson et al., 2010). The presence of another individual(s) is key to this step, through how it provides for both a feeling of safety (stage one) and a limited, but necessary connection to the larger community (stage three). As the memory of traumatic experiences is often powerful, disjointed, and lacking in linearity, telling the story of one’s trauma is often a difficult experience. However, the story telling process is important through how it allows one to remember the experience in a safe setting, assert agency, piece together an often jumbled experience, and mourn the loss due to the event. Through the story-telling or ritual process, one becomes better acquainted with the impact of the traumatic experience on oneself and one’s new, post-traumatic, identity.

           

Stage Three: Re-integration

           

Stage three moves from the individual work of stage two to reconnection with one’s family, community, and society. Just as stage two involves the important role of a witness to hear one’s story, interaction with others is central to this final stage in the healing process. This is especially important when the traumatic event has been perpetrated by other human beings rather than due to natural circumstances. Undergoing deliberate acts of violence, abuse or torture often leaves the victim feeling they have had their humanity stripped from them (Weisel, 84). In this stage, the newly constructed self is re-introduced to society and walks through the challenges that associating with, caring for, depending on, and loving others can entail. In those with mild symptoms, this can take the form of learning how to incorporate changes to one’s personality or appearance into existing relationships. In those with more severe or prolonged symptoms, this can be a long and demanding process of learning how to engage with and trust others for what may seem like the first time.

           

Resources

 

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders. Washington , D.C.

 

Andreasen, N. (1985). Posttraumatic stress disorder. In H. Kaplan and B. Saddock (Eds.). Comprehensive Textbook of Psychiatry. Baltimore: Williams and Wilkins.

 

Berceli, David. (2009). Conflict resolution & Post Traumatic Stress Disorder: A dialectic. TRE. Retrieved from http://traumaprevention.com/2009/07/24/conflict-resolution-and-post...

 

Herman, Judith. (1992). Trauma and recovery. New York: Basic Books.

 

Herman, Judith. (1995). Complex PTSD. In G. Everly Jr. and J. Lating (Eds.), Psychotraumatology: Key papers and core concepts in Post-Traumatic Stress. New York: Plenum Press.

 

Thompson, S., Kopperud, C., Mehl-Madrona, L. (2010). Healing intergenerational trauma among Aboriginal communities. In Ani Kalayjian and Dominique Eugene (Eds.). Mass Trauma and Emotional Healing Around the World. Santa Barbara: Praeger.

 

Wiesel, Eli. (1958). Night. New York: Farrar, Straus, and Giroux.

 

Wilson, J. (1995). Historical evolution of PTSD. In G. Everly Jr. and J. Lating (Eds.), Psychotraumatology: Key papers and core concepts in Post-Traumatic Stress. New York: Plenum Press.

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Ryan Nichols is a graduate student in the Master of Arts Program in Conflict Resolution at Georgetown University. His research interests often find themselves at the many intersections of health and conflict. He is currently in the process of applying to medical school and looks forward to a career that incorporates the benefits of productive engagement with conflict into health-related efforts both domestically and internationally.

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Tags: Conflict, Health, Mental, Resolution, Trauma

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Comment by Danielle Ancin on September 21, 2012 at 2:47pm

Thanks for posting on this important subject, Ryan!  I believe the impact of trauma on the way we behave as individuals and as a society is too often underestimated.

For people suffering acute trauma, talking about the incident and cultivating safety and community may be adequate.  But for communities suffering from years of violence and conflict, the trauma may be more complex and require interventions that address both mind and body.

Neurological research has shown for that people who have suffered complex trauma, the key brain centers that govern language, thought processing, and body awareness are turned "off." (Namely, the medial prefrontal cortex and the insula.)  For this reason, talk therapy does not always reach those suffering complex trauma.  The imprint of trauma is carried in the body, and needs to be reintegrated through working with the body.  Bessel van der Kolk has done extensive research on complex trauma – here’s a short, clear article on the subject: http://www.traumacenter.org/clients/MagInside.Su09.p12-13.pdf  His research on  trauma-informed yoga has shown that it is indeed an effective treatment for trauma, at least as effective as current CBT-based methods if not more.

I work as a trauma-informed yoga instructor with incarcerated and at-risk youth in Oakland, California.   I have also done yoga-based work with IDP’s and youth in Colombia.  I am extremely interested in intergenerational trauma and trauma healing for families and communities.  Let’s keep the conversation going!

Comment by Rachel Rafferty on September 21, 2012 at 10:41am

Thanks for posting on this topic. It is an important aspect of building peace which is often overlooked!

Comment by Tracy Dexter on September 20, 2012 at 3:42pm

This is an interesting use of this page!  Thank you for sharing this information, beginning with the basics!

Comment by Laura Mirsky on September 20, 2012 at 2:04pm

On this subject, the International Institute for Restorative Practices (IIRP) Graduate School is offering a 4-Day participatory  event: Restorative Responses to Grief, Trauma and Adversity, on how to employ restorative practices such as restorative conferences to respond effectively to serious incidents, as well as skills for responding to trauma and grief, including “compassionate witnessing"; the grieving process from a fresh and practical perspective, and addressing the essential issue of self-care in work with traumatized clients in high-stress environments. Offered in Bethlehem, PA: Englewood, CO; NYC, NY; Akron, OH. See http://www.iirp.edu/grief

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