Why are some folks plagued by the after-effects of trauma while others seem to sail through, acknowledging their grief and loss, but then going smoothly on to the next phase of their lives? It’s easy to say that this person is “weak” or that person is “strong.” But how appropriate—or accurate—is it to dismiss someone’s emotional response by such a qualifier?
There is a young woman who is very dear to me. Let’s call her Bella, because she is beautiful. Bella suffered repeated acts of emotional and physical violence as a child. I say “suffered,” as if the events are in the past. Certainly she is physically “safe” now—as much as any one of us is, anyway. But occasionally at night she calls me in a gut-wrenching, sobbing panic because she is desperately afraid to be alone. And she says she can’t remember a time when she didn’t hate her own body.
Despite these paralyzing moments and self-deprecating thoughts, she has had quite a few amazing successes. In the absence of role models during her adolescence, she still developed a business acumen and work style that many people twice her age could learn from. At the age of 21, she has two jobs. (She recently texted a picture of her new business card that says, “Manager.”) She’s also in school. And last year she negotiated one helluva deal on a new car.
But when Bella isn’t successful in a particularly difficult class, she doesn’t really believe that it’s because growing up she had to divert her attention away from learning how to learn because she needed to concentrate on surviving childhood. Instead, she reduces the problem to, “I’m guess I’m just too stupid,” and stops answering her phone for a couple of days.
So much more is known now about the pathophysiology of post-traumatic stress disorder (PTSD), depression, and anxiety than was known when I was Bella’s age. Our class this week discussed the effects of violence on victims. The assigned readings provide insight on critical differences between individuals who develop PTSD and those who demonstrate “resilience.” There is much to support the hypothesis that both genes and environment are key players in predicting emotional response to traumatic events. Sapienza and Masten (2011) cite positive adult relationships and effective parenting (among others) as correlates of resilience in young people, while Binder, et al (2008) in an earlier reading, implicate genetic patterns that predispose someone to developing PTSD in the face of certain life events.
Bonanno (2011) suggests that resilience is not as rare as was previously thought, and that previous recommendations for anyone who experiences a traumatic event to do “grief work” were flawed. With this understanding, I can appreciate my good fortune that I was emotionally unscathed after each of two situations in which I was held at gun-point, quite sure I was about to die—once at the hands of a stranger during an armed robbery, and once by my (now ex-) husband. My mother, with her wry wit, says to me, “Oh, you’re tough as a boiled owl!” Perhaps. But no one can tell me that I am anywhere close to being as strong as Bella, who, in the depths of an acute episode of depression and anxiety one holiday weekend a few years ago, sat alone in her apartment for two dark days doing battle with her insurance company until she finally got “approved” to get the help that she urgently needed.
As a nurse and clinician, I can clearly see the benefits of understanding how and why any given individual might be at greater risk for developing long-term mental illness after being subjected to violent acts. I can validate for Bella that her depression and anxiety are neither a result of any failure on her part, nor an indication of a hopeless situation. And that’s good—she needs to know these things, and to have them repeated to her often.
But being a nurse is not my only role. I’m also the mother of a young adult who hopes to raise his own children in this world one day. And I’m bringing up the very rear of the Baby Boomer generation, so I think about the people who will take care of me as I age, and about what I can do now to help them as they progress in their lives. We all share the grief and pain when someone perpetrates violence on another. We may not all have the same experience, but we are all hurt when one of us is hurt. When Bella’s heart is breaking, the world she and I share is darker, less bountiful, more contracted. And so we share a moral (and practical) imperative to shore each other up and provide what is needed, when it is needed, and how it is needed, sans judgment and marginalization.
In other words, Bella, I will always be there when you need me to remind you that you’re smart, interesting, beautiful, and relevant. Likewise, as my hair gets grayer and my bones become more brittle, I know you’ll do the same for me.
Binder, E. B.; Bradley, R. G.; Liu, W.; Epstein, M. P.; Deveau, T. C.; Mercer, K. B.; Tang, Y.; Gillespie, C. F.; Heim, C. M.; Nemeroff, C. B.; Schwartz, A. C.; Cubells, J. F.; Ressler, K. J. (2008). Association of FKBP5 polymorphisms and childhood abuse with risk of posttraumatic stress disorder symptoms in adults. Journal of the American Medical Association, 299: 11 (1291-1305).
Bonanno, G. A. (2004). Loss, trauma, and human resilience: have we underestimated the human capacity to thrive after extremely aversive events? American Psychologist, 59: 1 (20-28).
Sapienza, J. K.; Masten, A. S. (2011). Understanding and promoting resilience in children and youth. Current Opinion in Psychiatry, 24 (267-273).