Collective Trauma, Acute Stress Disorder and PTSD

The survivors of the most recent Paris terrorist attacks are all predictably going to have varying degrees of Acute Stress Disorder and or PTSD symptoms, from having witnessed the killings around them.   The citizenry at large can be also vulnerable to experiencing a milder form of trauma aftermath, even though they did not directly witness the violence.

Health care personnel, such as doctors, nurses, psychiatric clinicians, or anybody directly involved with treating terrorist attack victims, may also have collective trauma.

Even seeing a media replay of the shootings and cadavers can produce trauma like symptoms in some, especially those who are more impressionable, sensitive and of a younger age.   Violence of any sort will impact each individual, but the response may be different depending on several factors such as genetics, personality makeup, psychiatric illnesses,  cultural adaptations, and previous exposure to violence.

I thought I would describe the difference between collective trauma aftermath, from Acute Stress Disorder and PTSD. The first will involve ordinary citizens living in an area, campus, city or country where there has been a recent violent traumatic event where loss of life took place.

Those who did not directly witness the violence, nor were directly involved with care of victims, but shared a commonality with the victims, such as being a student in the same school, living in the same neighborhood, city or country can experience some degree of societal aftermath trauma.

Not everybody is going to be affected, but those who do will have the majority of these symptoms.  Increased anxiety about their personal safety will be the most prominent.  In cities or schools, where violence has occurred during everyday activities of living such as the recent terrorist attacks here in Paris, this rips away the basic fabric of security we generally enjoy.

Most of us never contemplate to overt possibility of being murdered at school, the theater, work, a restaurant or concert for example. When this occurs, we are suddenly hit that it could have been us too.

Although, we are all aware that we will someday die, this makes us all confront our own mortality is a very blatant way.  Death no longer belongs to the old and sick, nor soldiers in war, or dare devils, but can occur in an instant doing what we presume are very safe and secure activities of living.

I was confronted with this at a very early age, when my younger cousin was run over by a truck when I was 9 and when my older cousin, with whom I was very close and considered her like a sister died from complications from a  cardiac arrest during wisdom teeth surgery, when I was 11.

Increased vigilance and sensitivity to our immediate surroundings that can border on paranoia and panic.  We saw that Saturday, when a crowd of mourners visiting the sites of violence, became convinced that another attack was occurring giving way to panic and a mass rush of people to safety.

Avoidance is also extremely common, in that many are going to avoid the outdoor terraces so prominent in this city, as many were scared to take the RER B or metros after multiple subway attacks in 1995.  All of these symptoms are very common and are a normal response to any tragedy of this sort.

These symptoms subside with time, but not always, leaving residual fear, avoidance or plain discomfort associated with certain places.   This is due to the brain having had neuronal encoding or tracings  in the amygdala, which is associated with emotions and memory.

As a strong empath, who is very sensitive to energy around me, I will not visit the sites of recent carnage, preferring to light candles in prayers at home and church.   There are even certain places in Paris, that I avoid due to overwhelming emotions that are associated with massacres or the French revolution.

Acute Stress Disorder, ASD is what you will see immediately in those who directly witness the carnage that may turn into PTSD at a later date.  Anytime a human being is confronted with intense fear of dying, overwhelming helplessness, and absolute horror, the psyche is totally overwhelmed and the adrenals and some neurons surge massive amount of adrenalin hormones.

Initially, after any trauma, there is immediate shock and  a numbing out occurs as  a psychic breaking mechanism and even partial amnesia of the traumatizing event.

The key feature is a shock so psychically disturbing that the person may have dissociation, which means having a sense of unreality, transient disorientation, even doubt parts of their body are real or connected.  In generic terms “in a daze”.

Some will have problems of even relating details, or will have transient amnesia, which can be initially protective in nature.  They stare off in a blank manner and will have blunted emotions due to emotional numbing.

Most will have intrusive replays of the violent scenes, nightmares, insomnia, hyper vigilant and arousal.  There is always increased anxiety and depressive symptoms too.  ASD to be diagnosed must be at least 3 days minimum and occur within a month of the trauma.

Treatment of these patients is providing immediate sense of security and safety, orientation if necessary, and relieving immediate symptoms with anti anxiety medications and sleep agents.  Probing  questions should be gentle and open ended rather than specific, so as to not disturb  whatever psychic coping processing is in place.

Family members or friends should step in and ensure that they are eating, maintaining  hygiene and obtaining some measure of sleep, and staying with them, as they should not be let alone for a while.  Making simple decisions for them is helpful at this time.

Providing emotional support and comfort is essential, as well as reassurance of their safety. Listening over and over to recounts of the trauma is helpful, but allow them to talk as they need without probing.

Sometimes trauma victims will develop full blown PTSD.  The symptoms are basically the same but now intensified, except for overt dissociation. They are now so severe that they become incapacitating  with a chonicity that normal pretrauma activities are disturbed.

Severe depression sets in , sometimes with chronic anxiety and panic.   Feelings of hopelessness often leads to suicidal thoughts and gestures.  An alarming rate of completed suicides are  unfortunately happening  amongst American veterans of Iraq and Afghanistan invasions.

Dissociation and disorientation may occur in flashbacks, which are very prominent in PTSD patients. Having personally witnessed these, I can testify to how terrifying they can be to the patient, who literally  believes they are reliving the trauma.

These flashbacks can be triggered at any time by smells, noises, tastes, visions, media replays, situations, faces, and even by weather changes. These patients are so constantly aroused and hypervigilant that they easily present acute startle reflexes and pilo erection(hair raising).

Avoidance is usually cross the board and they will not only avoid being near any situations and places associated with the violence, but certain activities, transports or  being around certain ethnicities.

Over reliance of alcohol, and drugs to numb out the pain can turn some into having addictions.  Medications, such as antidepressants, anti anxiety and mood stabilizers are generally instituted, along with psychotherapy on a regular a basis.

It is very important that these patients be seen often, with individual and group sessions.  Medication checks only are totally insufficient, as these patients need appropriate time with compassionate therapists, where they can feel a sense of sincere care and protection.

PTSD patients can become so emotionally disabled that familial relationship can deteriorate and be torn apart.  Children of PTSD patients suffer likewise due to the chronic emotional numbing, which can contribute to generational trauma.

I have seen this in post Vietnam war veterans children, and in second generation of holocaust victims. If your parents were emotionally handicapped, then you as their children have a possibility of being hurt by their behaviors or emotional limits and can transmit these pathologies to your own offspring.

People who live in current war zones, or who have survived prolonged combat,  mass ethnic cleansing may be desensitized to varying degrees of violence with emotional numbing.  This happens when horrific life threatening violence was an everyday occurence or possibility.

Paris, like New York City, and Madrid will eventually recover, unless a new onslaught of terrorism occurs soon afterwards.  Paris has had her share of deadly famines, invasions, epidemics, black plague, bombings, and Nazi occupation.

Parisians essentially all want to get back to enjoying activities that Paris is famous for.  Strolling tree lined boulevards, soaking up sun in the many parks, leisurely eating, queuing up for their beloved baguette, drinking wines and beverages while taking in passersby or reading for hours at the thousands of outdoors cafés.

Yes, I am more frightened. Saturday, I walked to two stores, one quite a bit away, because outdoor food markets were canceled, and was definitely more vigilance than usual. I have always enjoyed a strong measure of personal safety here, much more so than in the states.

There is a joie de vivre that fills the air here.  The French have always had a flair to have fun, flirt, take their time to eat well and drink nice wines, and spend more time planning vacations or get aways, than worrying about accumulating money, material things or work.

Vive la France!