Monday, March 30, 2020

'The Intersection of COVID-19 and the Legacy of Trauma' by Georgina K Smith, PhD

“In the midst of this catastrophe, 
more than looking in to find serenity 
we need to look out for one another 
to practice humanity” – Abhijit Naskar

We need look no further than social media in this time of fear and uncertainty to be flooded with a stream of advice, coping suggestions, comparisons, judgments, shaming; divergent roads of seeming light and darkness. The lightness of planned days, structure, mindful practices, self-reflection and gratitude, and the ‘making the most of’ mentality veering vastly from the the darkness of despair, panic, loss of income, instability, isolation, sickness, flooded emotions, and grief. And our inevitable tendency toward comparisons doesn’t help matters. For many both the light and dark may co-exist, showing up in varying capacities depending on the hour or the day. 

Here’s the truth – there is no right way to navigate this. We are all swimming in unknown waters, and I am witnessing many people in different contextual stages of grief. There is no right way to show up or to cope. One person’s order is another person’s chaos. Your messy day as compared to someone’s peaceful day is not a measure of failure. Your only immediate task right now is to take care of yourself and get through this the best way you can… a temporary departure from the ideal of thriving versus surviving. Many of us are now navigating a triple threat of working/parenting/schooling all at one time. Many are still working on the front lines of a pandemic. Many have lost jobs, lost businesses, lost loved ones, lost their lives. Many can’t find employment. Ideas of moderate balance and self-care may be out the window. Or some may be able to rest into taking this time as an introspective journey. Conversely, your cup of coffee may be the only part of your day that holds any remnant of normalcy or routine. Many are describing feeling left out at sea without any sense of comfort or feeling led or taken care of, or feeling that they know which information to trust or listen to, and this may ignite another layer of distress for someone who has a history of this very experience. We are in one big storm together, but everyone is in their own individual boat, with their own individual set of stressors and resources. And our boats may all look pretty different. Circumstances are calling us to stay physically distant, when everything we need to get through this right now is support and connection. 

I work extensively with individuals who have endured some form of trauma in their lives, and as I witness various journeys, I am seeing something emerge during these times that has been less spoken about, so much so that I felt moved to write about it in the hopes that it may resonate for more people and perhaps help in some way. For those that have a history of trauma, they may enter this time in a bit of a paradox. There will certainly be a multitude of different responses, many who will be triggered into their past by the current experience of uncertainty, fear, lack of safety, restriction, isolation, lack of control; these experiences perhaps mirroring their childhood. And they may experience an increase in emotional dysregulation and distressing symptoms during these times. Those who struggle with addiction are also at greater risk during this time, with a combination of uncertainty, isolation, and being alone in their head with which to contend. There are other individuals who have traumatic histories who may have a different experience. Their boat may be extremely worn down and weather beaten and it may not navigate storms smoothly, but the internal structure of their boat may have surprising reinforcement and bolstering that holds it together during these times. We might think of this in part as what research has identified as ‘grit’. 

But there’s something else. Individuals who have internal alarm systems stuck at a higher set point due to trauma often experience struggles and symptoms in part as a result of the mismatch of their outer world to their inner world during more ‘normal’ times. For example, they may experience a minor life disruption or conflict as something much greater than it is. Their defense systems are wired to perceive threat and thereby engage protective mechanisms such as flight, fight, or freeze. In a relationship conflict these may look like either running away from or avoiding the argument, becoming more combative and retaliatory, or shutting down completely. Consequently, there can be feelings of guilt and/or shame when they later reflect on their mismatched responses. In coping with these dynamics, patterns of self-medication or other escape mechanisms may develop in attempts to find temporary relief, which of course further reinforces beliefs of badness or failure that may be rooted in their internalized trauma narrative, and perpetuates the inevitable cycle of shame and need for escape. 

However, when a global pandemic arrives on our doorstep, some of these individuals may have a re-lived experience of the circumstances in the outside world once again matching their internal alarm system, matching their history. Their alarm is intricately wired to tune in to exactly these catastrophic circumstances. So for some, they may experience a paradoxical sense of calm even if they also experience moments of triggering and panic and fear. A state of familiarity and knowing in the fear and uncertainty. An odd sense of comfort and aliveness and function in the chaos. Finding function in the need to do something to keep others safe. There may be a sense of control despite everything being completely out of control. They may temporarily reduce certain need seeking behaviors because of feeling a familiar attunement to the crisis, because of the matching of inside and outside that is happening. The past feels once again present. The quarantine and self-isolation may also feel at times calming in the sense of feeling like there is permission to retreat, to have a break from ‘performing’ for the world around them, for them to feel safe in the controlled alone-ness and to have a sense of knowing where everyone is, giving them the experience of less exposed risk. 

The time that may be more challenging for some of these individuals is when they have to anchor their boat once the storm is done. Their internal alarm system may have a hard time letting go and downshifting, even though circumstances will no longer require the same level of emergency response. They may not feel the same level of perceived control, function, aliveness, and self-efficacy outside of this boat and this storm. This is when the flood may hit… the feelings that haven’t yet been felt, expressed, and moved through; the needs that may surface now that there is time and space for them to be reflected on and hopefully met. This may bring a new grief along with a historical grief for developmental longings that still exist, yearning for something that didn’t happen, yearning for attunement and needing to be seen, while watching the world march on in what may feel like a jarring and abandoning normalcy. There will be a call for a recalibration to the new normal, a meeting of the parts of oneself – the young parts, the protectors – and ongoing conversations with those parts in an effort to adapt responses to one’s present self and experiences and needs, to others, to life, and in an effort towards ongoing integration and healing. There will be a need for a tuning in to one’s body and what is being held in tension, needing discharge and relief, so that the brain can receive a message of safety and loosen the grip of the armed guards. 

Once upon a time there may have been a dire need for the proverbial firefighter to blast in to the room, coming to the rescue to put out the fire – the fires of traumas once taking place. And with a global pandemic, the internal firefighters have a job. They are resurrected and purposeful. Once we land and acute crisis passes, the firefighters may still want to blast into the room, only they are not needed now in the same way. And the water they blast when there is no ‘fire’ may create more damage that will need repair. The trauma story will beg to evolve and change to match the ‘you’ today, the one that survived and holds all the resources and strength and courage and grace. And when the old noise revisits and gets too loud, we get to try and reach in and imagine turning down the volume, choosing how we respond to the story being spoken and choosing what we give energy to. 

As we navigate these unprecedented times, it is important that we all create space for the nuances of our own experiences and needs; that we have permission to be just where we are – now and when this ends. When this ends, it may just be the beginning for many people, whether that is coming out of a sense of triage to face the feelings that have been necessarily compartmentalized, or the beginnings of rebuilding a business, surviving financial loss, or experiencing the loss of a loved one to COVID-19. There will be a strange alchemy of relief, hope, and agonizing grief. A reorganization of how we experience and perceive our lives in this world. We all bring different histories and different frameworks of experience and personality that become the lens through which we view and respond to crises and through which we relate to one other. Stay aware of your story and your needs. Let your voice be heard. It doesn’t matter what it sounds like right now – as long as it is yours. Compassion and grace - practicing imperfect humanity for yourself and others - is our way through. 

If you are feeling engulfed by this unknown and by the circumstances you now find yourself in, try and find at least one air pocket, just for today, whatever that looks like for you, and try to focus on the most immediate present moment right in front of you. And if it’s too much to be present in this, imagine a time when you felt safe and happy. Use every one of your senses to go back to that place in your mind. Feel how it felt to be in that moment and feel where it lives in your body. Forget a day at a time, take one step at a time. And for trauma survivors, while the internet is going to be a vital lifeline of social connection for you in so may ways right now, be sure to seek out the healthy online spaces of support that allow you to be seen – as is. Place limits on other spaces that may flood you with triggering news (you can be informed without being flooded), or spaces where parts of you may travel down the social media comparison rabbit holes seeking glimpses of yourself, seeking the reflection and attunement you missed, yet finding and attaching instead to (mis-)interpreted reinforcers of long held negative core beliefs, or more simply put – old ghosts. 

Coping tools of reality-testing (do I have evidence for what I am feeling/saying to myself right now?) and perspective-taking (considering alternative interpretations and possibilities from your initial perception and interpretation of a situation) are going to be your friends here, helping you build corrective experiences around perception, connection, and attunement. There’s a flood of messaging coming at us via social media right now – condemning, informing, applauding, comparing, validating, permitting, educating, inspiring, reflecting, questioning. And we are hearing a lot about opportunities for growth in this crisis. And I believe there are opportunities in crisis. But know this - you don’t have to be there yet. You don’t have to be at the post-traumatic growth, meaning-making part yet. We are still in this. Some people need to make meaning to cope. But some can’t (yet). That’s ok. 

Tune in to your stage of grief and what you need. And what you don’t need. Maybe you’re in denial about all this. Maybe you’re angry. Maybe you’re all over the place emotionally from day to day and everything feels like static and it’s hard to take things in or feel soothed, similar to trying to soothe a colicky baby. Try and be gentle with yourself. Seek out any other sources of input in your day aside from responsibilities. Maybe that’s a nap, a movie, a podcast, a guided meditation, music, art, reading a book, fresh air, talking with a friend or family member, a shower, exercise, screaming in a pillow. Create a framework of structure and routine to your day that works for you – for some that may be minimal bookends to your day and for others it may look more planned by the hour. Honor what feels less pressuring and more adaptive for you. Monitor your mood, your responses, your needs. Name what you are feeling and going through – without judgment or past critical echoes. Meet parts of yourself where they are at with compassion and acceptance. When we move toward something instead of fighting it, our capacity to change it increases. Limit time spent alone wondering down rabbit holes in your mind. Isolation can amplify underlying fears in ways that are not helpful. And as we exist in this new normal, we will need to create new diffusion methods, ways to redirect, distract, regulate, soothe ourselves. Define a comfort zone – internally or externally - for yourself and spend time in it each day, whether it’s for 5 minutes or 1 hour.  Maybe it’s your bed or your couch, sitting outside or playing with a pet, talking with a loved one or visualizing a place or memory internally. And play the ‘What is the first thing I/We are going to do when this is over?’ game. Maybe it’s going back to your favorite restaurant or going to hug the people you have missed the most. It is important to create some space for future plans and goals when the right here/right now feels like too much. For individuals who have lost loved ones while being in lockdown, losing the ability to say goodbye, when this is over it will be important to step into the spaces of mourning and memorializing that were taken from you. And finally, seek professional help if you need it. Therapists are available online during this time. There are also hotlines available if you find yourself in crisis. 

We are in our boats together. We will come ashore from this storm. We will land. And wherever we find ourselves, we will be together in that too. 


RESOURCES

National Suicide Prevention Lifeline
1-800-273-8255

Crisis Text Line (USA)
Text ‘HOME’ to 741741

National Help Line for Substance Abuse
(800) 262-2463

Online Meetings – Alcoholics Anonymous

Search for a therapist in your zip code. They have listings based on expertise, telehealth (online/phone options), sliding scale options, and whether they take insurance. 

COVID-19 RESOURCE AND INFORMATION GUIDE – NAMI (NATIONAL ALLIANCE ON MENTAL ILLNESS)

COVID-19 MENTAL HEALTH RESOURCES






1 comment:

  1. This is very very informational n informative. The addition of Web sites is a plus. Thank you!!

    ReplyDelete