Life after trauma
An article for She Inspired Her
Written by Dr Eleanor Akaho, MBChB MRCPsych
Written by Dr Eleanor Akaho, MBChB MRCPsych
There are moments in life that are simply indescribable. Moments
that make the word “trauma” seem so minuscule and inadequate. Words don’t do
it. Silence doesn’t do it. Nothing can do it justice because it is exactly the
opposite of that: an injustice.
The recent attacks in London for example are a prime example. So many words have been written and reported about what went on in these major cities in the United Kingdom and now, as we seek to find a way to move forward, we are facing the age-old question: “Where do we go from here?”
The recent attacks in London for example are a prime example. So many words have been written and reported about what went on in these major cities in the United Kingdom and now, as we seek to find a way to move forward, we are facing the age-old question: “Where do we go from here?”
For many young people, this may be the first time that they
are having to deal with loss and existential questions. This means that many
families may be experiencing their children or teenagers go through the
grieving process for the very first time. It can be an extremely confusing
period for all involved. There are so few clear-cut answers when it comes to
life after trauma but as someone who works with children and adolescents who
have emotional, perceptual and behavioural difficulties, I endeavour to offer
some information and advice to help you to support your young people.
“Where do we go from here?” Many other questions stem from
this: What is normal grieving and when does it become pathological? What is a
normal stress reaction and when does it become post-traumatic stress disorder? What
signs should we be looking out for in our young people? What can we do to help?
And where can we seek professional help when the support of family and friends
simply isn’t enough?
Let's look at the normal grief
process, delayed grief, prolonged grief and depression:
The first thing to bear in mind is that the “normal”
response to trauma or tragedy exists on a large spectrum; what works for one
person will not necessarily work for others. One of the greatest ways that we
can support one another in the aftermath of tragedy is to respect these
differences. It is helpful to recognise that grief has been identified as having
five main stages: anger, denial, bargaining, depression and acceptance. These
stages can occur in any order and it can take several weeks or months for
individuals to work their way through each one.
It is common for sleep patterns, appetite, interest in socialising and many other aspects of everyday life to be disrupted during periods of grief. Some children may show evidence of regressive behaviours such as bed-wetting or thumb-sucking whilst grieving. Teenagers may face existential questions and if they feel they have no platform to discuss their observations and concerns, this can further compound the depressive stage of grief. Some may adopt negative coping strategies such as deliberate self-harm, excessive use of alcohol or drug use, and this can cause complications that delay the grieving period.
It is common for sleep patterns, appetite, interest in socialising and many other aspects of everyday life to be disrupted during periods of grief. Some children may show evidence of regressive behaviours such as bed-wetting or thumb-sucking whilst grieving. Teenagers may face existential questions and if they feel they have no platform to discuss their observations and concerns, this can further compound the depressive stage of grief. Some may adopt negative coping strategies such as deliberate self-harm, excessive use of alcohol or drug use, and this can cause complications that delay the grieving period.
Usually, most people begin grieving straight away following
a loss. The initial shock is often said to wear off within a month, although
completing the grief process is known to take several more months. Most young
people will be able to resume school within the first month after experiencing
a trauma, unless there are physical limitations. However, grief is sometimes delayed, meaning
that a young person may not begin to pass through the stages of grief until
several weeks or months after the loss. This is sometimes due to having an
ambivalent relationship with the person they have lost, but can also be due to
lack of social support, issues with addiction or experiencing a life crisis
immediately before the loss (such as serious illness or another major loss).
As young people represent a cross-section of the general
population, it is inevitable that a proportion of them will go on to develop
depression. It can be difficult to differentiate between prolonged grief and
depression as there is a big overlap in symptoms. In both cases, the young
person may appear low most of the time, their concentration may be impaired and
they may not be eating or sleeping normally. In these situations, it may be
best to involve your GP if this goes on longer than a month in order to aid
early diagnosis of depression.
Acute stress reaction
and post-traumatic stress disorder
Unexpected trauma may give rise to heightened uncertainty
and anxiety in the context of feeling unsafe. On average, most people undergo a
one-month period in which they describe symptoms of what is sometimes known as
an “acute stress reaction”. This involves similar symptoms to grief and
depression but tends to last less than a month. If it goes on for longer than
this, the young person may be experiencing post-traumatic stress disorder
(PTSD).
PTSD falls into the category of an anxiety disorder. It
often develops within six months of witnessing or being involved in a
significantly traumatic incident. As with other anxiety disorders, a young
person may experience physical symptoms as well as psychological and social
ones. These include headaches, upset stomach, pounding of the heart, nausea,
the feeling of a lump in the throat and mild breathing difficulties. These are
caused by an increased level of stress hormones in the bloodstream.
If you are the parent or carer of a child or teenager who
has been significantly affected by trauma or tragedy, here are some indicators
of post-traumatic stress disorder to look out for:
Difficulty remembering some parts of the trauma
Emotional numbness
Difficulty concentrating due to preoccupation
with the trauma
Re-enacting the trauma through play
Impulsive behaviours (in young people who were
not previously impulsive)
Aggressive behaviours (in young people who were
not previously aggressive)
Hyper-vigilance – they may be extra-sensitive to
noises and seem suspicious of people
Nightmares or difficulty sleeping
Flashbacks (often preceded by triggers)
Avoidant behaviours – they may not want to go
out and will especially avoid anything that reminds them of the trauma
Clingy behaviours – they may worry about being
left alone
Regressive behaviours they may resume behaviours such as bedwetting
or thumb-sucking
In more complex cases, the young person may
report or be seen responding to images or sounds that others cannot see or hear
What can parents or
carers do to support children and teenagers?
Do not force them to talk about the trauma in
detail; this may actually re-traumatise them.
Listen to them when they are ready to talk and
do not judge or try to dictate their feelings.
Discuss happy memories of the person they are
grieving for. Also, consider holding a memorial service for the person where they
can express themselves and fellowship with others who are grieving the same
person.
Acknowledge that a bad thing that no one could
control has happened and they are likely feeling scared, confused and maybe
even resentful as a result of no one being able to prevent it. Be open and
truthful; you may want to express your own sadness regarding your inability to
protect them or make things better.
Reassure them that in the same way bad things
happen in the world, good things also happen. Perhaps you can help to re-adjust
their worldview by looking up real-life stories about people pulling together
to help others in the community.
Be aware of special dates such as birthdays of
those they’ve lost or anniversaries and try to do something special on those
dates.
It is important to emphasise that the child or teenager’s
age, gender, personality and previous encounters with adversity may all play a
role in how they are affected and how they respond to support.
Seeking extra help
If you are worried that a loved one is experiencing abnormal
grief or post-traumatic stress disorder, the first advisable step would be to
sensitively express your concerns to them. In some situations, this may be
enough to pave the way for honest conversation and you may realise that the
situation is not as severe as you had imagined. If, however, further help is
indicated, it is advisable to encourage the person to visit their GP. Older
children can see the GP without their parent being present if they prefer. The
GP will be able to assess whether referral to a counselling organisation will
suffice or whether secondary mental health services are required. This may
sound alarming to some but it is important to bear in mind that only a very
small proportion of people will end up requiring such services and the vast
majority of cases will be managed on an outpatient basis.
About the author
Eleanor Akaho is a medical doctor with a specialist qualification in Psychiatry. Her passions are promoting positive personal development and encouraging mental health awareness. In addition to clinical work in Child and Adolescent Mental Health Services (CAMHS), she is the co-founder of My MindSight, a newly-launched mental health education service for secondary schools. Their aim is to educate, enlighten and empower young people about topics related to mental health and the impact of bullying. For further information, please email the team at my_mindsight@hotmail.com
Our sister company, Inside
Out, supports young people by holding
social events in which guest speakers use the arts to share their experiences
of mental health difficulties. To find out about their upcoming event, please
email the team at info.insideoutuk@gmail.com
Seeking additional help and information:
For further information, the following sites are recommended:
www.cruse.org.uk
Where Do We Go From Here Article by Dr Eleanor Akaho
Forward by Crystal King UK of Celebrity Creations Management
Where Do We Go From Here Article by Dr Eleanor Akaho
Forward by Crystal King UK of Celebrity Creations Management
Life After Trauma: Where Do We Go From Here? An article by Dr Eleanor Akaho for SheInspiredHer.com
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