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Trauma Healing
 
By
Eric Brahm


January 2004
 

Those who have experienced hardship and suffering often experience lasting trauma from the experience. Traumatic events can fundamentally change not only victims' way of life, but also their psychological outlook. This is equally true for natural disasters such as earthquakes and floods as it is for man-made catastrophes of terrorism and war. Man-made trauma, however, is often more difficult to deal with, because frequently the perpetrators still live in close proximity to victims -- thereby providing constant reminders of the past, as well as the threat of further incidents. Even if the immediate source of the trauma is removed, time does not necessarily heal all wounds. The survivor may, in fact, continue to suffer, to appear "frozen in time." With conflict remaining an unfortunately common reality for many, techniques have emerged to help trauma victims interpret and heal from their experience.

What is Trauma?

"I believe that imagination is stronger than knowledge -
That myth is more potent than history,
I believe that dreams are more powerful than facts -
That hope always triumphs over experience -
That laughter is the only cure for grief.
And I believe that love is stronger than death."
 -- Robert Fulghum taken from http://www.robertfulghum.com/

Individuals can suffer trauma in a variety of ways and for a variety of reasons. Trauma sufferers may themselves have seen their homes or communities destroyed or be victims of physical abuse such as rape, torture, or other violence. Trauma can also be induced by serious threat or harm to loved ones.[1] Individuals are often unable to cope with these extreme events, consequently inhibiting both their ability to carry on with life and to function in society. [2]

Trauma can have a range of different cognitive, emotional, physical, and behavioral effects on individuals.

Cognitive responses include memory difficulties, lack of concentration, poor judgment, inability to discriminate, and inability to make choices.

Emotional responses include depression, withdrawal, excitability, flashbacks, intense fear, feelings of helplessness, loss of control, loss of connection and meaning, generalized anxiety, and specific fears.



Additional insights into trauma healing are offered by Beyond Intractability project participants.

Physical responses include stomach pains, tightness of the chest, headaches, perspiration, and psychosomatic complaints.

Behavioral responses include irritability, startling easily, hyper-alertness, insomnia, communication difficulties, and drug, cigarette, or alcohol abuse.[3]

All told, victims of violence often feel humiliated, vulnerable, helpless, and that their lives are out of control.[4]

According to Herman, post-traumatic stress commonly manifests itself in three ways.[5]

  • First, hyper-arousal arises from continual vigilance in hopes that the experience will not occur again.
  • Second, the traumatic memory is omnipresent in the mind of the traumatized. The memory repeatedly occurs as a flashback, which can occur at any time, and the victim is unable to distinguish the memory from actually experiencing the event again.
  • Third, traumatized individuals appear to be indifferent in order to mask the feelings of vulnerability and helplessness.

Through its effects on individuals, trauma also has a dramatic influence on communities. For example, when trauma becomes prevalent, society can lose the sense of trust. Trauma also has a way of spiraling out of control. Human rights violations create massive trauma, which can, in turn, fuel additional human rights violations and so on. Feelings of trauma can generate feelings of frustration and revenge that can produce a cycle of violence and also perpetuate feelings of victimhood on all sides of the conflict. Shared trauma generates a "we-feeling," but also creates an "us vs. them" mentality.[6]

Unresolved trauma can also be transmitted across generations.[7] Trauma-induced social divisions can form the basis of historical myths that can come to be a central part of group identity. These myths can be activated consciously or unconsciously and ignite conflict in the future. In Yugoslavia, for example, President Slobodan Milosevic reactivated a historical trauma by disinterring the body of Prince Lazar, who was killed in the Battle of Kosovo in 1389, and ceremonially reburying the body in one Serbian village after another. This served to revive the mourning process as if Prince Lazar's death had occurred yesterday. This helped mobilize the population producing renewed conflict and inflicting new trauma.[8]

Healing can prevent future violence and facilitate reconciliation. Staub and Pearlman go so far as to argue that reconciliation is necessary if groups are to live together peacefully. By reconciliation, they mean "coming to accept one another and developing mutual trust. This requires forgiving. Reconciliation requires that victims and perpetrators come to accept the past and not see it as defining the future as simply a continuation of the past, that they come to see the humanity of one another, accept each other and see the possibility of a constructive relationship."[9]

Providing Healing
The ordinary response to atrocities is to banish them from consciousness. Certain violations of the social compact are too terrible to utter aloud: this is the meaning of the word unspeakable. Atrocities, however, refuse to be buried. Equally as powerful as the desire to deny atrocities is the conviction that denial does not work. ... Remembering and telling the truth about terrible events are prerequisites both for the restoration of the social order and for the healing of individual victims.[10]

Many argue that trauma will not go away unless it is actively confronted. This is, in turn, contingent on a full airing of the details of the crimes. "Psychological restoration and healing can only occur through providing the space for survivors to feel heard and for every detail of the traumatic event to be re-experienced in a safe environment."[11] At the same time, it should be made clear that the trauma cannot be erased. The goal of trauma healing "is to acknowledge the experience and integrate it into a sort of personal or collective rebirth."[12] As such, trauma healing can contribute to a program of social reconstruction.

Healing requires a focus on the victim. Prosecution is often not feasible in post-conflict situations due to a corrupt judicial system or one that is unable to handle the volume of cases it would be faced with. For the purposes of healing, trials are also poor because they center on the rights of the accused.

Many often assume that truth commissions can provide trauma healing, but this is a potentially dangerous assumption.[13] Truth can provide acknowledgment and validation to be sure. For some, going to commissions and witnessing that they are not alone in their suffering is comforting. However, trauma healing often requires long-term support, and truth commissions on their own cannot provide this. Typically, victims are given a small amount of time to tell their story. What is more, resources are often in short supply, limiting the degree to which follow-up services are available.

Testimonies, memorials, and group ceremonies may be helpful for healing, but there is also risk that these acts could reinforce oppositional identities.[14] Finding common goals to work toward facilitates engagement. Local initiatives seem better able to promote healing. There has been a significant expansion in programs designed to do just this.

Approaches to Trauma Healing

The goal of trauma healing is to give victims a feeling that they have control over their lives again. Herman identifies three stages that trauma victims move through as part of the healing process: safety, acknowledgement, and reconnection.[15] These processes have guided the creation of many trauma healing programs.

The first step for most programs is to provide a safe space. A feeling of safety will encourage victims to open up and reveal details of their ordeal. Retelling the details of one's story can be therapeutic and allows those memories to be incorporated into the victim's life story. When the story is told in the presence of the other, it can lead to acknowledgement, apology, forgiveness, and reconnection. Julia Chaitin describes several such processes in detail in her essay in this knowledge base on Narratives and Story Telling.

Gutlove and Thompson discuss another such project: the Health Bridges for Peace Project[16] That process begins by involving trauma sufferers in "constructive communication," in which they tell their stories and the rest of the group listens attentively, respectfully, and compassionately. Many programs also emphasize the therapeutic value of drawing or writing about their trauma.[17] Then, participants discuss the difference between debate and dialogue with the goal of realizing the latter. Finally, participants are trained in active listening, which both allows the listener to understand and empathize with others and to better articulate one's own thoughts and feelings. This process helps facilitate reconnection with one's social environment and allows the victim to restore their place in society.

The ethnic conflict that erupted in the 1990s unfortunately provided ample opportunity to develop and refine techniques for trauma healing. A brief survey of some of these efforts follows.

In The Former Yugoslavia

Amongst others, the Medical Network has utilized a variety of tools to facilitate healing in the former Yugoslavia.[18] Community Integration aims to empower marginalized groups and help them adapt to the new social context. Volunteer Action on the part of trauma victims is also important because being active and helping others can help restore the feeling of worth in trauma sufferers.

In Rwanda

The horrific genocide in Rwanda has been extremely difficult for survivors to overcome. A new word entered the Rwandan vocabulary in 1994, ihahamuka, which refers to a variety of psychological manifestations thought to originate from the genocide. The word comes from bringing together two words: hana (lungs, respiration) and muka (without).[19] Victims suffered not only from posttraumatic stress disorder, but also from chronic traumatic grief. The latter was widespread a year after the genocide. Because 91 percent?of survivors did not have a chance to bury their relatives or perform mourning ceremonies, and nearly as many had not yet seen the remains of loved ones, the bereavement process has not been allowed to take its natural course.[20]

The importance of tailoring healing techniques to local conditions is exemplified by work done in Rwanda in the aftermath of the genocide. Programs utilized writing or drawing about one's experiences, but because Rwanda is an oral society, reflection and discussion in small groups about their writing and drawing proved useful. Lectures were also conducted to help victims understand why the genocide occurred, what effects these types of experiences can have on individuals and communities, and how healing can be achieved.[21] A series of radio programs was also produced and broadcast around the country to help people understand and deal with their feelings.[22]

The best evidence supports the continued use of these types of programs. Surveys conducted two months after the end of treatment indicated trauma scores significantly lower for a group treated through integrated community programs, relative to a control group.[23] The treatment group also exhibited "conditional forgiveness," in other words, a willingness to forgive perpetrators, provided they acknowledge what they have done.

Those With Unique Trauma Healing Needs
Women and Children

Women are often in particular need of trauma healing. They may themselves be victims of traumatic experiences such as rape or incest. However, they are also more likely to be left behind after husbands and children are killed in conflict. Women are often humiliated, feeling that they could do nothing to stop the violence. What is more, the loss of a husband or children can make it difficult for women to provide for their families, thereby adding further humiliation.

Children also face particularly difficult trauma. They lack the emotional development and life experience to make sense of the trauma, even more so than adults. Jarman observes in Chechnya that traumatic events often produce rage in teenagers due to the fact that their lives have been turned upside-down; they've essentially been robbed of their youth.[24] Children are also susceptible to picking up attitudes from adults in their lives, thereby providing the opportunity for trauma to be transmitted across generations. For this reason, it is particularly important to focus on children in the healing process.

Practitioners

It should be noted that trauma healing can have adverse effects on listeners, those helping victims recover. This is because the terrible stories can have a psychological effect, particularly as story after story piles up in the listener's memory. In truth commissions, for example, commissioners and staff have reported suffering secondary trauma at having heard the harrowing stories of victims.[25] What is more, in trauma healing programs in Yugoslavia, those who worked to aid trauma victims developed feelings of trauma not only through exposure to stories, but also by being present in the environment that gave rise to the original victims' trauma.[26]


[1] Hugo van der Merwe and Tracy Vienings, "Coping with Trauma," in Peacebuilding: A Field Guide, Luc Reychler and Thania Paffenholz, eds. (Boulder, CO: Lynne Reinner Publishers, Inc., 2001), 343.

[2] Gutlove, Paula and Gordon Thompson, eds. Psychosocial Healing: A Guide for Practitioners. (Cambridge, MA: Institute for Resource and Security Studies, May 2003). http://www.irss-usa.org/pages/documents/PSGuide.pdf

[3] Gutlove and Thompson 2003.

[4] van der Merwe and Vienings 2001, 345.

[5] Judith Lewis Herman, Trauma and Recovery (New York: Basic Books, 1997), 35.

[6] United States Institute of Peace. 2001. Training to Help Traumatized Populations, Special Report 79. http://www.usip.org/files/resources/sr79.pdf

[7] Ervin Staub and Laurie Anne Pearlman 2002 CREATING PATHS TO HEALING http://www.heal-reconcile-rwanda.org/lec-path.htm (No longer available as of March 5th 2013 - See Pearlman, L. Gubin, A. Gimana, A "Healing, Reconciliation, Forgiving and The Prevention of Violence After Genocide or Mass Killing: An Intervention and its Experimental Evaluation in Rwanda" (2005) for related information)

[8] United States Institute of Peace. 2001. Training to Help Traumatized Populations, Special Report 79. http://www.usip.org/files/resources/sr79.pdf

[9] Ervin Staub and Laurie Anne Pearlman 2000. Healing, Reconciliation and Forgiving after Genocide and Other Collective Violence http://www.restorativejustice.org/articlesdb/articles/1273

[10] Judith Lewis Herman, Trauma and Recovery (New York: Basic Books, 1992), 1. Emphasis in original.

[11] Brandon Hamber, "Do Sleeping Dogs Lie? The Psychological Implications of the Truth and Reconciliation Commission in South Africa," seminar presented at the Centre for the Study of Violence and Reconciliation, Johannesburg, July 26, 1995, 4-5.

[12] Gutlove and Thompson 2003.

[13] Hayner, Priscilla B. Unspeakable Truths: Confronting State Terror and Atrocity. Routledge, 2001.

[14] Ervin Staub and Laurie Anne Pearlman 2000. Healing, Reconciliation and Forgiving after Genocide and Other Collective Violence http://www.restorativejustice.org/articlesdb/articles/1273

[15] Judith Lewis Herman, Trauma and Recovery (New York: Basic Books, 1992).

[16] Gutlove and Thompson 2003.

[17] Ervin Staub and Laurie Anne Pearlman 2000. Healing, Reconciliation and Forgiving after Genocide and Other Collective Violence http://www.restorativejustice.org/articlesdb/articles/1273

[18] Gutlove and Thompson 2003, 16-23.

[19] Athanase Hagengimana. 2001. After Genocide in Rwanda: Social and Psychological Consequences. http://www.isg-iags.org/newsletters/25/athanse.html

[20] Athanase Hagengimana. 2001. After Genocide in Rwanda: Social and Psychological Consequences. http://www.isg-iags.org/newsletters/25/athanse.html

[21] Ervin Staub and Laurie Anne Pearlman 2000. Healing, Reconciliation and Forgiving after Genocide and Other Collective Violence http://www.restorativejustice.org/articlesdb/articles/1273

[22] The radio programs http://www.labenevolencija.org/

[23] Jill D. Kester. 2001. From eyewitness testimony to health care to post-genocide healing Successes and Surprises in the Application of Psychological Science. APS Observer Online. (July/August) 14:6. http://www.psychologicalscience.org/observer/0701/pressymp.html

[24] Roswitha Jarman. Healing as part of conflict transformation. CCTS Newsletter 12. http://www.c-r.org/sites/c-r.org/files/newsletter12.pdf

[25] Hayner, Priscilla B. Unspeakable Truths: Confronting State Terror and Atrocity. Routledge, 2001.

[26] Gutlove and Thompson 2003.


Use the following to cite this article:
Brahm, Eric. "Trauma Healing." Beyond Intractability. Eds. Guy Burgess and Heidi Burgess. Conflict Information Consortium, University of Colorado, Boulder. Posted: January 2004 <http://www.beyondintractability.org/essay/trauma-healing>.

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