Language can scarcely describe the butchery in Ukraine. And we know that alongside the physical suffering is a devastating psychological suffering. Ukraine is an increasingly traumatized nation, collectively and individually.
What is trauma? A Greek word meaning ‘wound’ or ‘injury’, trauma happens when the mind’s defences are overwhelmed, when its protective shield is pierced and when one’s worst nightmares come true. A person’s capacity to objectively distance themselves from something terrible disappears. Outside and inside become one.
The two main types of trauma
There are two main conditions arising from trauma. One is Post Traumatic Stress Disorder (PTSD) and the other is Complex PTSD. PTSD is often associated with shell shock or combat fatigue in military situations so you can easily imagine it being widespread in Ukraine. But it can also be caused by events like train crashes, terrorist attacks, serious health problems or losing a baby.
Complex PTSD springs from trauma that is repeatedly experienced over a significant period of time without any chance of escape and often in the context of a family relationship in childhood. Some examples of that would be physical, emotional or sexual abuse, neglect and witnessing domestic violence. I’ll run through some of the symptoms of PTSD and Complex PTSD in a moment.
What’s happening in the brain
Recently Dr Joanne Stubley who leads the adult section of the Tavistock Trauma Service, gave a powerful public lecture at the Guildford Centre for Psychotherapy. She talked about what happens in the brain when trauma occurs. Three areas of the brain are involved – the amygdala, the hippocampus and the prefrontal cortex. The amygdala is the brain’s smoke detector and it’s where a threat is first experienced. The amygdala goes into overdrive producing an exaggerated fight/flight (and if that doesn’t work ‘freeze’) response. Everything feels huge.
The usual job of the hippocampus is to help us file our experiences and put them in context. If there’s too much fear around the hippocampus goes offline. What we’re experiencing doesn’t get stashed in our memory files but stays put for the future as if it’s happening now. That explains the flashbacks, nightmares and intrusive images that trauma sufferers often report.
The prefrontal cortex enables us to think, feel and relate to others. It won’t work very well if the amygdala is in overdrive. So people who’ve been traumatized will often shut down and avoid relational experiences.
Ukraine’s trauma and us
Incidentally, what we are all currently seeing and hearing about Ukraine may be affecting us in similar ways. For instance, finding ourselves powerless to do much, we too may experience something of those fight/flight or even freeze responses. Certainly many people are being affected by considerably heightened anxiety as a result of contemplating the horror of Ukraine.
Symptoms of PTSD
The symptoms of PTSD may include those flashbacks, nightmares and intrusive images that I’ve mentioned, along with a feeling that the original event is happening in the present, because of the failure of the hippocampus’s filing system. There may be a wish to avoid people, places, thoughts and feelings connected to the event. Thoughts and moods generally may be negatively impacted and a person may suffer from hyperarousal (being easily startled) which comes from that exaggerated, overdrive response in the amygdala. In addition, there may be a sense of being on guard, a tendency to be easily angered and a difficulty in concentrating or sleeping.
Symptoms of Complex PTSD
Someone suffering from Complex PTSD might have similar symptoms to those of PTSD but with more besides. There may be a real difficulty in regulating emotions which can lead to self-harm or suicidal thoughts. There may be a general feeling of helplessness, big difficulties with trust and a sense of shame, guilt, defilement and self-blame that makes the individual feel different from everyone else. (A fundamental difference between PTSD and Complex PTSD is that the former is based on fear and the latter on shame). There may be a lot of ruminating on the relationship with the person who perpetrated the abuse, perhaps with an unrealistic attribution of power to them, even if the events are in the distant past and the perpetrator is now elderly. Or there might be revenge fantasies. In addition, there might be ongoing difficulties in managing relationships and an unconscious repetition of the past whereby the victim of abuse bafflingly finds themselves again in abusive relationships.
Both PTSD and Complex PTSD often include bodily symptoms. Events that can’t be processed by the mind frequently become lodged in the body.
Dissociation
PTSD and Complex PTSD feature dissociation. I’ve talked about a ‘freeze’ response occurring during trauma. Part of that is an automatic and last-line-of-defence mechanism where there is a detachment from the overwhelming original experience – an involuntary ‘playing dead’. Victims of trauma will say ‘It didn’t feel like it was happening to me’ or ‘I looked at the ceiling’. Joanne Stubley calls dissociation ‘the escape when there’s no escape’.
As well as this, she points out that dissociation means not just detachment but also the sealing-off of the traumatic experience(s) in another part of the mind. But the seal isn’t perfect so the experience leaks out in (again) intrusive images, nightmares and bodily sensations that are actually repetitions of the experience; in an acting out of the original events in symbolic ways in the present without realizing it; and in auditory hallucinations. Then there are phenomena such as amnesia (gaps in memory lasting anywhere from minutes to years), depersonalization (a sense of disconnection from your body or thoughts) and derealization (a sense of disconnectedness from the world around you).
Trauma and Easter
I’m writing this shortly before Easter. Whatever one believes or doesn’t believe about the historical events surrounding the first Easter, it’s true that crucifixion means being nailed down, helpless and overwhelmingly ‘done unto’. It’s the opposite of being an active agent of one’s own situation. It is, therefore, about being a victim of trauma, both physical and psychological.
But the Easter story doesn’t end there and it goes on to tell of the transformation of death into new life, and of despair into hope and a new future. In a similar way there is hope for people who have gone through trauma because a range of therapies exist which hold out the possibility of significant healing.
Countless victims of the war in Ukraine would already benefit from such help. Given the numbers involved, one wonders how realistic that is but let’s hope that some of them at least get the professional care they need. And we can dare to hope that one day the ravaged country of these brave, brave people will be re-built and a new future will be theirs.
No words!