Category Archives: Post-Traumatic Stress Disorder

August 3, 2016 · 3:11 pm

What is trauma-informed care? Filling a gap within care ministries


Yesterday I had the good pleasure of sitting with key leaders of organizations involved in trauma healing around the world. Much of our focus was on what these organizations were doing around the world (successes and challenges) and how would we function together in an alliance. You might expect we spent most of our time talking about projects and activities. You would be right.

However, I was given a few minutes in the afternoon to open up a dialogue about how we ensure that our organizations are adequately trauma-informed, for the sake of both our target populations as well as our own staff members.

What is trauma-informed care?

Last year I did this podcast for The Samaritan Women to introduce the topic of TIC. The idea, in short is that organizations serving traumatized individuals and communities would have a base understanding of trauma (what it is, how it impacts bodies, behaviors, spirits, relationships, etc.) and how to provide quality care that does not re-traumatize or hinder recovery. Of course, all human service and ministry agencies want to help. But, we know that not all that we do, even when well-intended, is helpful. Thus, there is a need to review policies and procedures to see how well we are serving others. If trauma victims tend to lose voice (power), relationships, and meaning, then do our organizational activities support the reversal of these losses?

For agencies seeking to self-evaluate around TIC categories (safety, trustworthy and transparent, peer-support, mutuality, empowerment/choice, and considering culture) start with assessment tools found at samhsa.gov or other TIC websites. The tools can help you consider gaps in training, policies, and interventions.

But don’t forget…

No organization will be adequately trauma-informed without caring also for staff members. It is tempting to put all the focus on how we care for our target population and completely forget about the staff who are doing the work of trauma-recovery. We can neglect their self-care, neglect the reality of secondary trauma. Most who are attracted to trauma healing (or as we said yesterday, those who get bit by the bug) are likely to neglect their  own emotional and physical health for the sake of helping others.

So, ask a few questions:

  1. Are your trauma healing specialists given voice for how to serve others, in building strategic plans?
  2. Are their ample opportunity for staff to voice concerns and complaints from staff policies to implementation? Can they evaluate their superiors in appropriate ways?
  3. What organic self-care opportunities are built into the organization?
  4. If a staff member begins to show signs of their own trauma, will they be cared for or will they be seen as weak and suspect? Is help only provided after the fact or as a prevention strategy?
  5. What opportunities for continuing education and mentoring exist?
  6. When was the last time you surveyed emotional, relational, spiritual safety within your organization?

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June 9, 2016 · 8:14 am

Is there a best practice in international trauma recovery work?


Yesterday I presented with Marianne Millen at the 2016 Humanitarian Disaster Institute conference here in Wheaton, IL. We reviewed some of the lessons learned through our experiences partnering with Rwandan institutions like the Bible Society (BSR) and with local counselors and caregivers. Check out our presentation here if you want to see our slides.

In short, partnerships are the way forward. But partnerships are not merely so that “we” can help “them.” True partnerships share resources, knowledge, and skills. They enrich both parties. I can attest that I have learned much from my Rwandan friends as they from me. I am a better therapist (and maybe teacher) from what I have received.

Partnerships rarely form quickly. They take time, can be messy, are likely more expensive than other intervention strategies. But as the Rwandan proverb says, “If you want to fast, go alone. If you want to go far, go together.” And yesterday during a conference plenary, Sheryl Haw (Micah Global) had this to say, “partnerships are the realization of being on God’s mission and not our own.”

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May 25, 2016 · 10:33 am

4 Reasons I Promote Scripture-Based Trauma Healing


[Note: broken link fixed. If anyone is interested in taking this course with me this summer, see here.]

As a psychologist I have had a front row seat to observe the destruction that traumatic experiences have on individuals and families. And as a professor training future counselors I see the necessity of passing on best practices for treating those with symptoms of posttraumatic stress disorder (PTSD). New understandings of trauma’s impact on bodies, minds, souls, and relationships appear on the pages of our academic and clinical journals. As a result, I read daily about innovative attempts to hasten trauma recovery for individuals and even whole communities.

With a world filled with trauma, it is clear to me we need an army of psychologists and mental health practitioners. How else could we address problems faced by 60 million displaced peoples in the world at present? How else could we address the scourge of sexual abuse, where worldwide 1:4 women and 1:6 men have experienced sexual violation before they reach the age of 18?

So, given the needs I have just mentioned, why would I spend considerable time and effort to promote a bible-based trauma healing training program? Let me tell you four key reasons I think this program is essential to address the world-wide problem of trauma. [Note, this is NOT a paid advertisement.]

Trauma disrupts faith and identity. The church must be at the center of the response

While many practitioners recognize the physical and psychological symptoms of PTSD, fewer have noticed that trauma disrupts and disables faith and connection to faith practices. Just now the scientific community is beginning to track this problem and acknowledge the role faith plays in the recovery process. Some are brave enough to suggest that failing to utilize faith practices and communities in the recovery process is tantamount to unethical practice! But most mental health practitioners have had zero training and experience engaging faith questions as part of treatment. The field of psychology is waking up from more than 100 years of training practitioners to ignore, even reject, faith as essential to healthy personhood. If faith is essential to most people on the planet then any intervention must engage faith and spiritual practices if it is going to consider the whole person.

Dr. Diane Langberg recently reminded a world gathering of national Bible Society leaders that trauma needs in the world are far too large for any government to handle. The only “organization” in the world situated to respond to at both a micro and a macro level is the Church. But is the church prepared? We need the church willing to understand the nature of trauma and participate in supporting faith and Bible-based healing responses. These responses include practices the church has not always been known for: validating, supporting and comforting victims, speaking up about injustice, inviting individual and corporate lament, re-connecting oppressed people to God. We need the church to be a safe community for victims.

The Healing the Wounds of Trauma (HWT) program fills this void. It offers basic trauma education, illustrates how God responds to traumatized peoples and provides simple yet effective care responses average believers can enact without being professional caregivers.HWT_USA_2014

While I believe we psychologists with specialized skill sets are essential to trauma recovery, much of what we do can be done by every day individuals. I tell my students that most of counseling is not rocket-science. Being present, listening well, building trust, validating, asking good questions, and walking with someone in pain is largely what helps counselees get better. With a little training, the church can be at the forefront of the trauma healing.

But we need an army…of capable trainers who reproduce

There are approximately 2.2 Billion Christians in the world today. If we decided (and I am not suggesting this AT ALL!) to only serve traumatized Christians, we do not have enough capable practitioners to serve those in need. The ONLY way we would be able to serve this population is to train up capable trainers (wise, able to work well with others, understand group dynamics, know when to be quiet, etc.) who are then able to reproduce themselves and make even more trainers who subsequently serve ever increasing populations. This creates a cascade effect—1 trains another who each, in turn, trains others. Conservatively speaking, one training of 35 future trainers could reach up to 15,000 traumatized people in 3 training generations.

To maintain quality, the program must be able to be delivered and passed on in a consistent manner. The HWT program is designed not merely to educate participants regarding trauma symptoms and good care/healing practices but how to pass on such knowledge and skill to others. The facilitator (trainer) handbook provides a wealth of information to ensure that the quality does not erode as the information is passed on.

Experiential learning trumps lectures every time

In the West, we cherish academic lectures as the primary training mode. Lectures enable a speaker to give a large amount of information in a short period of time, with minimal interruption. A good lecture casts vision, identifies problems, and points to effective responses. But a lecture cannot produce skilled practitioners. Any academic mental health program worth attending will require practicums where head knowledge is put into repeated practice.

Consider this scenario. My father is capable of building a house. He sits me down and he spends hours gong over the steps to building an addition to my house. I listen, take notes, and even handle the tools that will be used. Am I prepared now to build the addition? No! If I am to build a proper addition, I will need to do so under his close supervision. In fact, most of the hours of lectures are not necessary at all. What will be more effective is his teaching me as we build together.

The HWT program is all about experiential learning. Participants learn as they experience trauma and trauma healing through story, dialogue, and practice. First applied to self and then in consideration of others. This is in stark contrast to most continuing education programs that amount to little more than monologues and passive audiences. While the monologue may give more information, it is highly unlikely that participants can in turn teach what they heard to others. The HWT program is not designed to deliver large amounts of new academic information. And yet, what participants get via experience and practice will be far more easily passed on when they become the teacher. There will be no army of trainers if we cannot quickly get experience and practice and pass on what we learn in simple everyday language.

Good training hinges on contextualization

If trauma is universal, then it might be thought easy to deliver trauma healing training across cultures. This is not so. If I prepare a lecture or training on trauma in my context (the megalopolis of the Northeastern seaboard of the United States) but deliver it on a different continent, my training may be of minimal value. The reason it is sure to fail is that what I had to offer didn’t fit the context; it didn’t speak to the heart of that audience. Good training must be contextualized so that participants immediately recognize trauma in their settings and that interventions make sense. Imagine if I deliver a talk on good conflict skills to a hierarchical society but emphasize the need to speak in “I” language (I need, I feel, I would like)? Such interventions will rightly be rejected as inappropriate. And if experience holds, whatever else I say will also be rejected.

The HWT program is founded on contextualization. Not only has it been translated into many different heart languages, the central stories and illustrations are also contextualized so that the participants can see themselves in the stories and interventions. At heart of each lesson, participants are asked about their own culture’s take on the particular problem. In dialogue, they compare responses to that of biblical passages highlighting trauma, grief, loss, and pastoral care. Nearly every major training point addresses context and encourages participants to develop creative interventions in keeping with key biblical and psychological foundations.

…

Is the HWT program all a traumatized person needs? No, it doesn’t assume this. Is the HWT program perfect? Of course not. I continue to make suggestions for improvement and the authors and developers are some of the most flexible I know, always looking for ways to improve the materials and training program. There are many other solid programs out there, but few programs I know have refined the content and delivery systems to be able to scale out across the globe. I’m grateful for the opportunity to serve the Mission: Trauma Healing team at the American Bible Society as co-chair of their advisory council and occasional trainer.

For a more visual exposure to this training, see this downloadable documentary.

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April 1, 2016 · 7:00 am

Making the Church a Safe Place for victims of abuse


This Saturday I will be attending and presenting Cairn University’s Faith in Practice conference hosted by their counseling center and department (free but you need to register). I will be speaking about how we can make the church a safer place for adult victims of abuse and trauma. If you want to peak at the slides, click here: 2016 Cairn U Presentation.

The presentation that I will do will only be one hour so that limits what I can do. What I wish I could do is also talk much more about the systemic factors that make churches less safe places for vulnerable people. While we can all grow in better understanding the nature of trauma and how to walk alongside victims, our institutions can be systematically harmful, even when the individuals within the system have no intention to hurt others. Thus we need to keep examining the ways our systems operate that can be toxic to some. While this presentation doesn’t cover these questions, it can be good to ask,

  1. How do we handle recent or older allegations of mis-handling difficult cases?
  2. How do we handle allegations of child abuse (the victims, the family, the alleged perpetrator and family, and congregation)?
  3. Are we a safe place for people who are broken and not all tidied up?
  4. Does our system allow for ongoing lament? (Corporate and individual)?

 

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March 11, 2016 · 4:25 pm

Counseling Advice From Lady Gaga?


Lady Gaga has a new song about the aftermath of sexual assault. Unless you’ve been living in a cave, you likely have heard of Lady Gaga who is known for crazy getups and stunts. Known in my household as the lady who wore the meat dress, she sings these words (I’ve included just a few lines) in the song “Til it happens to you.”

You tell me it gets better, it gets better in time
You say I’ll pull myself together, pull it together, you’ll be fine
Tell me, what the hell do you know? What do you know?
Tell me how the hell could you know? How could you know?

…

Till it happens to you, you don’t know how it feels, how it feels
Till it happens to you, you won’t know, it won’t be real
(How could you know?)
No it won’t be real
(How could you know?)
Won’t know how I feel

Her message is clear: If you haven’t been raped or assaulted (or experienced any other sort of trauma) you can’t possibly know what it is like. And since you can’t know what it is like, stop giving superficial comfort and advice.

Is Lady Gaga right? Does she offer sound counseling advice?

Yes and no. Yes, we are far too willing to offer platitudes to people in pain and wonder why they get angry and hurt and avoid us altogether. Lady Gaga captures the sentiment of the doubly hurt–first by the initial trauma and second by foolish words. The ancient Greek Aeschylus aptly puts it this way

It is an easy thing for one whose foot is on the outside of calamity to give advice and to rebuke the sufferer

Our quips roll easily off the tongue, but they injure the already wounded. Before you speak to someone and offer your ideas, do your friend a favor and be quiet. Ask them again (and again) to tell you what they experienced (past or present tense). But I don’t think Gaga goes far enough. I would argue that EVEN IF you have experienced the same trauma as the person in front of you, stop thinking that you know what they are feeling and struggling with. You may, but you may not as well. Do not assume your experience is theirs. Listen. More than you think you need to. Assumptions of “getting it” communicate that their pain doesn’t really matter to anyone.

But also, Lady Gaga is wrong (and I get it, this is art not counseling skills training!). It is possible to help others even when you have not had their experience. As long as you approach your work with humility and the heart of a student, you can do much good. You bear witness to their experience through your reflections and observations. You can ask good questions and paint word pictures of trajectories of growth. Do not think that just because you did not have the trauma, you have nothing to offer. Offer yourself (more than your words). If you fail to offer yourself out of fear of not being adequate, you also harm by not giving the present of being understood.

But let Gaga’s anthem be a challenge to those of us, myself included, who speak before listening and who assume rather than learn. We won’t get it. But we can bear witness.

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February 29, 2016 · 10:07 am

Conference on Refugees and Trauma, March 15-17


If you are in the Philadelphia area, I want to give a final shout out for an important conference put on by the American Bible Society’s Mission: Trauma Healing. This will be our 5th (I think) Community of Practice conferences where trauma recovery practitioners meet to learn and encourage each other in the work of trauma healing. If you have never been before but want to hang out with folks doing trench work around the world, this is the place to be. Missionaries, mental health experts, ethnologists, linguists, pastors, humanitarians, and everything in between are the common attendees. This tends to be a rather intimate conference where you get plenty of time to talk around tables with folks doing what they talk about.

This year our conference theme is We are Sojourners: Refugees and Trauma (conference information and registration link).  What makes me excited this year is the diversity of presenters. We have well-known psychiatrist Curt Thompson presenting on attachment injuries related to trauma. We have presentations and a documentary unveiling about African Americans in the US (yes! Refugees can live in a land for generations and not be fully “home”). There will be presentations by Diane Langberg as well as presentations by experts on the current refugee crisis from the Middle East.

In addition, there will be this activity on Tuesday night which includes musician Michael O’Brien at historic Christ Church.

Those who have attended before should realize that this is now held in Center City Philadelphia at the office of the American Bible Society and not at the Mother Boniface Spirituality Center in the North East.

If you are interested in the wide world and burdened about trauma and refugees, come and meet your family!

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December 15, 2015 · 6:30 am

So, you want to support trauma recovery?


In recent years I have witnessed significant growth in public discussions of posttraumatic stress (PTS) and trauma. This is a good thing. We want to care well for victims of natural disasters and political and ethnic conflict. We want to care well for ex-combatants. While we work to stop the worldwide disaster of child sexual abuse and domestic violence we also want to care well for those we couldn’t protect.

What do I need to know to be able to help?

When we want to help solve a problem we look for solutions. Students in my counseling and global trauma programs see the problem (individuals and communities experiencing trauma symptoms) and come looking for solutions. They want to know which intervention strategies will be most effective in reducing or eliminating the problem of PTSD. It is a good thing to be skilled; skilled in diagnostics as well as treatment application.

However, knowledge and skills are not enough. Yes, a helper will necessarily need to know how to listen to trauma stories, how to speak and how to be silent. A helper will need to know him or herself in such a way as to recognize blind spots and other factors that may hinder the capacity to walk with a survivor. But even more importantly, the helper will need to recognize, and participate in the following trajectory of memorializing trauma while moving to recovery.¹

The trajectory of memory and recovery

  • The [trauma] Event took place: One must speak.

Having experienced trauma (the Event), speaking of trauma is a necessity if recovery is to take place. How one speaks and what is spoken will differ from person to person (thus, NEVER force someone to speak beyond what they want to speak). But whatever is spoken always leads back (explicitly or implicitly) to the Event. Nothing can be spoken without the Event in view. And resolution is really not possible. How does one resolve a genocide? A sexual assault. Rather, there is before…and after. The victim, as Brown says, “does not have the privilege of such a resolution…again and again” (p. 23). We listeners cannot fully understand, but we can listen and repeat what we have heard.

  • The Event defies description: One cannot speak.

When speaking, victims soon realize, “having tried to speak, they discover that attempts to speak of this Event are doomed” (p. 23). Brown notes that this places the messenger and listener into a double bind. It cannot be adequately spoken and understood. Normal language cannot do justice to what was experienced. If not, then the  trauma would cease to be evil, horrific and devastating but normal and inconsequential. The double bind is this: to not speak is a betrayal of the experience and to speak is a betrayal since words will always fail to do justice to what has been experienced.

Words must minimize the event to some extent. Consider 6 million Jews slaughtered or 1 million Rwandans. It is easy to speak those facts but in doing so we must minimize what those numbers mean. We cannot imagine unless we are there.

If we are going to recover and if we are going to support that recovery, we must sit with the fact that we cannot make sense of trauma. The human attempt to do so is normal…but impossible. Helpers need to avoid all attempts to answer the question of why even as we acknowledge that is is always on our lips.

  • The Event suggests an alternative: One could choose silence.

It must be recognized that victims can choose silence. In fact, silence can heighten our understanding of the unspeakableness of trauma. This is a silence that is chosen in an effort to highlight what is also being told. Consider Beethoven’s 5th symphony that has a rest just after the first four notes (dit dit dit dah [rest]). As Brown points out, the rest accentuates what has just been “spoken.”

One could (ought?) also to choose silence when descriptions of trauma will be used to critique the character of the victim. Too often when tales of trauma are told, listeners look for ways to minimize or explain away the events. “It wasn’t that bad…he didn’t mean it…it could have been worse…you’re fine now.” So, in light of these common experiences, victims and helpers have to wrestle with how and when to be silent.

But of course, silence may be the right choice for victims, it never is for observers. As Brown so starkly puts it,

Silence is no virtue; it is vice twice-compounded: indifference toward the victims, complicity with the executioners. (p. 36)

  • The Event precludes silence: One must become a messenger.

…speech betrays so we must forswear speech, but silence also betrays so we must forsake silence. (p. 36)

Per Wiesel and Brown survival by itself is insufficient. Survival must include testimony to those who live. They call it being a messenger from the dead to (and for) the living. The messenger’s job is to disturb and to awaken those who would rather not see or know of the trauma. Truth must be brought to light and wrongs ought to be acknowledged without explanations or reasons given. These things happened, period.

The messenger (and the helper) do not just speak truth to the rest of humanity but also to God. Like Job, like Jeremiah, like David, we contend with God through our questions and our laments. In the Christian world we tend to try to speak for God. But what if our time was spent raising our questions and our complaints to God? Such complaints do not have to be about our anger but rather because we cannot make sense of both the senseless–God and evil in the world.

  • The Event suggests a certain kind of messenger: A teller of tales.

If trauma presses the messengers (victim and helper) to speak and yet makes in next to impossible to effectively communicate what has happened, then the telling will have to be done in analogies. Brown suggests that storytelling is one way to bring victim and listener together. Consider how Nathan uses story to confront David. Such a story, per Brown, bridges two worlds and uses one (the story) to challenge or confront the other. Confrontations may be as direct as Nathan (You are that man!) but just as frequently these “confrontations” are affective and subtle. This is what happens when you find yourself crying during a movie that has tugged on your heart in ways you never expected. The story enables you to connect with feelings and experiences that may have just moments before, been distant and protected.

Why tell stories? Not just to have a feeling (Brown calls that merely an indulgence). Tell stories to change people; to call to action; to demand acknowledgement of injustice and movement to right wrongs.

A final thought: standing on sacred ground

This trajectory (struggle to voice, necessity of silence, becoming messengers and storytellers to call the world to action) does not often happen in a linear fashion. Rather, it happens in fits and starts; in quiet and rageful voices. But if you see evidences of someone attempting to speak about a trauma you are witnessing the Spirit speaking,

Likewise the Spirit helps us in our weakness. For we do not know what to pray for as we ought, but the Spirit himself intercedes for us with groanings too deep for words. 27 And he who searches hearts knows what is the mind of the Spirit, because the Spirit intercedes for the saints according to the will of God. (Rom 8:26-7)

When you see those groanings be silent. You are standing on sacred ground.

___

¹This trajectory of remembering trauma and becoming a messenger can be found in Robert McAfee Brown’s Elie Wiesel: Messenger to all Humanity, Rev ed. This book is a kind of commentary on Wiesel’s work and so this trajectory intersperses Wiesel’s quotes and thoughts with the authors. These five points are made by Brown on pages 20-49 in much greater clarity and artistry than I can in this space.

 

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May 16, 2015 · 11:57 am

Evil Hours (David Morris): A Must-Read for Mental Health Professionals


A bit ago, I blogged on David Morris’ new book, “The Evil Hours: A Biography of Post-Traumatic Stress Disorder” and his NPR interview. [You can read my previous post here.] Having just finished reading the text, I want to highlight a few more insights about the book.

Morris does an excellent job describing his experience of trauma and then expanding to the history of PTSD and its impact, both on those going to war and those who have experienced civilian traumas. For those who wonder why Vietnam vets struggle more than WWII vets, Morris helps reveal the falseness of that belief in the beginning of chapter 5.

But the most important chapters of the book are chapters 6 through 9 where he examines therapies designed for PTSD, how research protocols designed to help us know which treatments work best may harm, how drugs and alternative interventions (e.g., yoga) may help and how to think about posttraumatic growth.

Though these chapters are his experience, I would highly recommend every MHP to read these chapters. Skip the first chapters if you must (you should not!) but these are paramount if you are going to work with traumatized individuals. Here are just a few reasons why:

  • Following protocol for therapy can harm a patient. Don’t get me wrong, research IS necessary. But when a protocol is harming a patient, it is important to make sure that research goals do not become primary over the needs of the one who is in need.
  • Prolonged Exposure, the gold standard treatment, has a HUGE drop-out rate. Somewhere around 54%. That should give us great pause. Surgery hurts. PE is like surgery but repeated opening of a wound. The dropout rate should tell us that imaginal work can re-traumatize. There are other methods that may work just a well but do less damage in the process. I think about the changes in the last 10 years for breast cancer. We are discovering that not everyone needs bilateral breast removal to survive. Not everyone needs 30 days of radiation as radiation at the time of lumpectomy may work just as well for some patients. So, we must be less fixed in our minds on treatment protocols and be considering if the patient can improve with less radical treatment options.
  • Cognitive therapies are good but over-emphasize think right = feel right. Such work could ignore the moral complexity of life, especially for those who have moral injuries.
  • The person of the therapist is more important than the treatment modality. This is not to say that the modality is of no consequence. Rather, that good interventions live or die on the capacity of the therapist to be truly human with clients.
  • Recovery must be done in community. Gutting it out alone does not work.
  • Alternatives, like yoga, works for some far better than talking, but shouldn’t be sold as a cure-all.

…yoga stands out as a uniquely effective treatment, precisely because it insists that people shut up and start listening to their bodies. Yoga works to correct the central lie of Western philosophy, which goes all the way back to Descartes, who said that the body and the mind are distinct entities that exist independent of each other. (237)

However, Morris acknowledges that yoga is, “ridiculous”, even “moronic.” Though he is also quick to say, “In the Marine Corps, we had a saying: ‘If it’s stupid but it works, then it isn’t stupid.” (238). “Placebo, wishful thinking, whatever. I’ll take the help where I can get it.” (246, discussing the mixed evidence for EMDR). Yet, be wary of proponents of any one treatment as a cure. They prey on desperate people.

The bottom line is that there is no ‘magic bullet’ for PTSD, and claims to the contrary should be taken with more than a grain of sand. (240)

  • Growth happens but not apart from ongoing trauma symptoms and changes. Too often we expect recovery to mean the removal of symptoms. But, there is no going back. Identity changes, just as it would if you lost your spouse and then got remarried. Growth needs to be observed and underlined, but not assumed to eliminate strong, continuing reminders of trauma.

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March 24, 2015 · 1:40 pm

What does recovery look like after traumatic experiences


After trauma, what does recovery look like? Is it possible to “move on?” How can you when you can never unsee or unremember what happened to you? 

Is it possible to experience joy rather than emotional pain when remembering past or ongoing hurts? If so, just what does that look and feel like for the victim? What can be expected if I am “healed”? Can I be free from the typical experience of trauma (e.g., Hopelessness, despair, anxiety, confusion, shame, anger, loss of identity, feeling stuck but the demand to act as if the trauma did not take place, and spiritual angst over the goodness and love of God)?

As Diane Langberg has so aptly reminded us, “Trauma is the mission field of this century.” Around the world there is much openness to talk about the impact of trauma and to use spiritual practices as part of the recovery process. In Christian language, we talk about healing the wounds of the heart and one of the best programs out there is the Trauma Healing Institute’s, Healing the Wounds of Trauma. This program is based on the strong Christian belief that God, through the work of the Holy Spirit and the Scriptures,  is in the business of healing wounded hearts. At the heart of this belief sits two important passages:

Isa 61:1-4 The Spirit of the Lord Yahweh is upon me, because Yahweh has anointed me, he has sent me to bring good news to the oppressed, to bind up the brokenhearted, to proclaim release to the captives and liberation to those who are bound, to proclaim the year of Yahweh’s favor, and our God’s day of vengeance, to comfort all those in mourning, to give for those in mourning in Zion, to give them a head wrap instead of ashes, the oil of joy instead of mourning, a garment of praise instead of a faint spirit. 

2 Cor 4: 16-18 Therefore we do not lose heart, but even if our outer person is being destroyed, yet our inner person is being renewed day after day. For our momentary light affliction is producing in us an eternal weight of glory beyond all measure and proportion, because we are not looking at what is seen, but what is not seen. For what is seen is temporary, but what is not seen is eternal.  

These two beautiful passages present a picture of recovery. Good news, release, favor, comfort, joy and beauty in place of mourning and oppression. Renewal in the face of affliction. But what does this mean in real life? Does a “double portion” instead of shame feel like to a victim of sexual trauma? What does renewal and release feel like after a natural disaster? 

Prognosis for Complete Recovery?

If you suffer a serious knee injury requiring surgery, you will need time for rehabilitation. But rehab does not necessarily mean you will recover the full range of motion you once had, or that  your knee will be entirely pain free when you are finished with physical therapy. Your prognosis for recovery depends on many factors such as age, extent of injury, physical health prior to the accident, and availability of quality care. Even with the best care provided to top athletes, recovery may not lead to return to top form. For example, an Olympic skier may be able to ski again but not at a quality that allows for competitive skiing. 

What about the prognosis for spiritual and emotional recovery? Of course, just as in the knee injury example, the answer must be “it depends.” Still, considering the two passages above, words like liberation, joy, release, and renewal shape our imagination for recovery. Do we imagine complete recovery to top spiritual and emotional form, without pain and limitation? It appears to me that we sometimes imagine emotional and spiritual healing without taking consideration the reality of broken bodies and a fallen world. We are not guaranteed a pain free life or faith without distressing questions. In fact, Paul’s beautiful words in 2 Corinthians bear this out. afflicted in every way, persecuted, perplexed, persecuted, struck down, always carrying around death, burdened, groaning and more. Yes, he also says not crushed, not despairing, not destroyed, but alive. But both must be considered together at the same time if we are indeed to imagine our prognosis. Recovery means comfort and lament, joy in mourning, perplexed while trusting, dying yet alive. 

Sprouts of Justice and Recovery?

Isaiah describes sprouts of justice and righteousness beginning in the recovery of the oppressed (Isa 61:11). As a gardener, I see sprouts as the beginning of hope. After planting seeds, the tiny sprouts give me hope for a later harvest but that hope is still tempered with the knowledge of the challenge of getting sprouts to develop into fruited plants. I have to be vigilant about bugs, weeds, and drought. I need to cultivate and fertilize or my sprouts will not turn into much. And even if I do everything right, the seed may be weak or the weather may mean I only have spindly or stunted plants that cannot bear much fruit. Yet, the sight of sprouts brings the hope that empowers us to keep at the gardening work. 

So, what are these sprouts of justice and recovery that victims of trauma may first see that encourage hope and further empowerment? Consider some of these: 

  • Capacity to Name Truth and Justice

Recovery begins when oppressed people find words to name injustices done to self and other. For example, a victim of domestic violence may become well aware of the subtle signs of verbal and emotional coercion, long before any physical violence. They become the canary in the mine, aware of poison that others may not yet sense. 

As this capacity grows beyond a mere sprout, the person may be able to speak the truth aloud, even with courage to say it to leaders. 

As naming capacity grows, it moves from awareness of personal risk to capacity to notice and care for the injustices others experience

  • Accepting weaknesses without hopelessness

Part of recovery requires honest reflection of the damage done. Signs of recovery include the ability to recognize limitations and working within capacity without self-hatred (though there may be lament for losses of previously held abilities). When we truly accept the “new normal” we then can stop evaluating daily life from the perspective of who we used to be

As we accept our limits, we can then begin to see the opportunities we do have even within our limitations

  • Identify resilience and new capacities in the midst of struggle

There may be new capacities we never observed before (e.g., the capacity to speak up to power, the ability to withstand rejection, increased empathy for the pain of others). We now notice these resiliences and growth as they stand on their own

Though we will not call the suffering good, we will be able to identify blessings that we have received in spite of and as a result of the trauma experienced 

Be Careful Not to Damage the Sprouts

For those who are not attempting the impossible, to “move on” from trauma and abuse, it is good to remember that sprouts are tender and can be easily damaged with too much interference. You may need to leave a few weeds you see near the fledgling plants so as not to disturb their roots or bruise the green shoots. How do we do this to the sprouts of recovery? We may unintentional limit growth by questioning why the person learning to speak the truth isn’t doing it in a even-tempered manner. Sadly, too often those in domestically violent marriages are told to stop being so dramatic and to calm down when they begin to speak about the truth of the violence they have experienced. Or, we can point out the sins of the victim as if somehow their responsive sins eliminate their right to speak up about the trauma they experienced. Or, we can hear someone accepting brokenness and accuse them of not trusting God for complete healing. 

Nurture recovery as you would a tender plant. It is a scandalous act of grace! By paying attention to safety needs, by bearing witness to trauma, by being willing to lament and to stay connected, we provide a greenhouse for such plants to grow into levels of recovery never before dreamed of. 

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January 30, 2015 · 4:05 pm

PTSD “A Disease of Time”


David Davies, part of the staff of “Fresh Air” on NPR, has conducted an 35 minute interview with David Morris, a journalist who was embedded in a unit in Iraq and who suffers from PTSD resulting from an explosion he survived. David has written a book, The Evil Hours: A Biography Of Post-Traumatic Stress Disorder. If you want to better understand the experience of PTSD and its impact on a person, you should listen to this show (or read the transcript). For therapists, Morris discusses his experiences with Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT). He also describes the use of propranolol when repeating trauma stories.

Here’s a couple of my take-aways:

  • PTSD is a disease of time.

“…in some ways, PTSD is a disease of time. And a lot of people – PTSD is many things, but one of the things it is a failure to live fully in the present. And I think what happens a lot of times with traumatic – survivors of trauma is they have these compulsive returns to awful events, and they are unable to live in the now.”

  • The best treatment never removes all symptoms of PTSD

“The best we can do is work to contain the pain. Draw a line around it. Name it. Domesticate it, and try to transform what lays on the other side of that line into a kind of knowledge, a knowledge of the mechanics of loss that might be put to use for future generations.”

  • Honest reflections of the impact of PE and CPT (and why so many dropout from PE treatment)
  • Honest admission about the most common “treatment” of PTSD–alcohol (and evidence why so many end up abusing it!)
  • War traumatizes far too many but rape is 5x more traumatizing

[in discussing how helplessness/lack of control is a significant factor in the development of PTSD] “Yeah, the helplessness is one of the main predictors of who’s going to end up with PTSD and who doesn’t. And the idea that you have absolutely no control over your environment is very hard for people to deal with because, you know, you are basically completely helpless and unable to control your destiny and your survival….and that’s one thing I discovered in the book is I thought – you know, we sort of assume that PTSD is sort of the realm of soldiers and veterans, when in fact, the most common and most toxic form of trauma is rape.

…a soldier may have some control over his or her environment. They have a weapon with them; they can move; they can take cover. But oftentimes in the cases of rape, the victim is completely overwhelmed and trapped and cornered. And from the moment the attack begins, they are rendered almost completely helpless, which is interesting. And you see that in the diagnosable rates of who gets PTSD and who doesn’t. Rape survivors tend to have it almost 50 percent of the time, whereas your average war veteran – particularly for Iraq and Afghanistan veterans – the rate of PTSD diagnosis is more around 10 to 12 percent. So a rape victim – rape is, in a manner of speaking, five times more traumatic than combat.”

 

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