Before psychological trauma was recognized, debilitating reactions to horrible events was seen as shirking or malingering, a coward’s way of escape.  The war horrors of the Twentieth Century brought about a different understanding.  The symptoms of psychological trauma were labeled as ‘shell shock,’ ‘battle fatigue,’ and ‘war neurosis.’  Those early labels undermined the previous pejorative moral judgments.  It medicalized the experience, and allowed it to be treated.  The Vietnam War brought about increased attention to returning Vet’s painful reactions.  This scrutiny led to the current diagnosis of Post Traumatic Stress Disorder (PTSD).

Research on PTSD is extensive: the effects of 911, Afghanistan War Veterans, car accidents, cardiovascular issues, etc.  See https://www.research.va.gov/topics/ptsd.cfm . There has been extensive research on the physiological, psychological, and social aspects of PTSD.  Likewise, many treatments have been researched and are now offered ranging from Psychodynamic, Acceptance and Commitment Therapy (ACT) to Cognitive Behavioral Therapy (CBT) and Eye Movement Desensitization and Reprocessing (EMDR) therapy.  The research on the effectiveness of these shows mostly positive results.  Generally, I have found that if the practitioner shows care, consistency and respect, healing follows. 

It doesn’t take a crystal ball to predict that there will be traumatic reactions to this pandemic:  Invisible threat.  Death rates increasing.  Forced familiarity with family and/or roommates.   Physical distancing nationally enforced.  Inability to enjoy one’s usual pastimes.  The challenge of home schooling.  And all too frequently, the inability to make enough money to provide sufficient food for the family. 

Biologically, we are wired up to deal with stress.  One may go the route of Fight— The bully gets punched in the nose.  Or one may go the route of Flight— the gazelle flees the lion.  In recent years researchers have added Freeze as a response.  The predator appears and one freezes in the hope of not being seen.   In the short term, these responses are adaptive and can lead to survival.  The problems arise when the Fight/Flight/Freeze reactions continue on after the threat has passed.  The remote is stuck on one channel.  This pandemic is forcing us all into a Freeze response.

While we can’t know yet the psychological damage this pandemic may bring about, we can plot ways to avoid post pandemic trauma.  ‘Avoid’ may be too strong of a word here.  How about mitigate?  There are steps to lessen the psychological scars that will follow from this global crisis.  There are ways to build resilience.  First the bad news:

Ways to increase trauma potential

1. Drinking in excess, while briefly numbing, will lock the trauma into place.  Same with drugs.
2. 24/7 news watching may feel like staying on top of coping strategies.  In fact, it sends the neurological alert systems on overdrive.
3. Isolate and withdraw: while it may seem safer to keep away from everybody, we need the interaction to heal.
4. Argue/rage:  when a situation, like this one, brings about feelings of helplessness, we can feel more in control if we blame the ones closest to us.  Scapegoating never leads to healing.
5. Self blame: likewise, scapegoating the self creates so much internal static that we can’t calmly face the future.
6. Indifference as a way of dealing with this challenging and deadly pandemic leads to numbness.  And numbness is one of the hallmarks of PTSD.
7. Vicarious traumatization can be the wound of the empathetic helper.  This is a major danger for First Responders and caring professionals.  Frequently leading to burn out, it can create psychological paralysis.
8. To deny our emotional reactions in the midst of ongoing fear, vulnerability and grief may seem safer, but the lasting impact again can be numbness and PTSD.
9. Acting out against our vulnerability by challenging the common sense public health requirements may being a brief sense of being in control, but it can also lead to both physiological and psychological damage.
10. Worry, worry, worry-  Anxiety and rumination tends to reinforce itself creating more worry.

Ways to build resilience (daily practice):

1. Social support:  If there’s one thing I’d recommend above all others, it’s having a trusted buddy.  He/she can share the pain, confusion, strategies, and hopes.  Usually it’s better to have a couple, or even several.  No one person, partner, spouse, friend can do it all.  
2. Physical activity:  Getting stuck on the ‘Freeze Channel’ backs up the stress hormones which can lead to cardiovascular damage as well as an inability to psychologically heal.  Keep active.  Everyday!
3. Mindfulness:  There has been a lot written about this practice recently.  There are plenty of apps.  See https://psych.ucsf.edu/coronavirus/apps
4. Creativity:  Creativity by definition facilitates changing mindsets.  And this then adds to our ability to change from a pre PTSD approach to more of a resilient mind set.
5. Self compassion: given the entire world is going through a bit of hell, this is a great time to cut yourself some slack.  You don’t have to be the perfect home teacher, the great wage earner.
6. Spiritual approaches:  though we can’t attend our places of worship right now, we can pray, meditate, talk with our spiritual guides, our AA sponsors.
7. Acknowledge hard emotions:  Both fear and shame are foundations of PTSD.  They are natural reactions to this global crisis.  By not denying these and the ability to build a tolerance for these unpleasant emotions now, we don’t have to get process them later.  
8. Acknowledge our limitations: The Serenity Prayer sums it up:  God, grant me the serenity to accept the things I cannot change, courage to change the things I can, and the wisdom to know the difference.  This saying is common now in AA and other 12 step programs was written by Reinhold Niebuhr and has its roots in Classical Stoicism.  
9. Help out:  Those who pitch in to help do better both in the short and long run. These contributions can range from an economic donation to helping making masks, to bringing food to the elderly.  Do it for others thereby you do it for yourself.
10. Humor:  As W.C. Fields said, “There comes a time in the affairs of man when he must take the bull by the tail and face the situation.”

Go easy, folks