Dealing With Trauma

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Make Sure You're Fit To Be There

If you are setting out on a mission or helping to prepare others - where do you start? 

Firstly, it is important to think about our motivations for going. If we are desperate to help and distraught at the plight of those we want to assist, then we might not be emotionally stable enough to bear the work. This isn't a failure - this work isn't for those who feel exceptionally emotionally involved.

It's important to know ourselves and our triggers. It's almost a cliché to say every war is my war, but for those of us who have already been affected by war, sexual trauma, displacement, it might be too difficult to expect yourself to be able to cope with situations we are likely to face in the field.

You can't help anyone while you need help yourself. Armies have rigorous psychological training programmes that you aren't getting, so in some ways you have to perform them on yourself. Be honest about what you know you'll face and how you expect to react (obviously, we can't always predict this but, if you find yourself in tears watching the news, wracked with guilt and dying to help, you might not be the best person for the job.)

Eat And Rest (Seems obvious, right?)

Once you're on a mission it's important to bear in mind the basics. In humanitarian aid and journalism, nobody tells you to stop work and go to bed, to take a day off, to eat and sleep on a timetable (three hots and cot in British army speak), but it's important to impose one of these regimes on yourself. If you haven't had a good night's sleep will you be more or less able to help? Easy. Of course it's hard to stop working when, for example, you know there are still people pouring across the border in desperate need. There is an infinite amount of help needed. But you could work 24 hours a day for ten years and still not do enough. So it's very important to limit the time you spend working and to allow yourself to eat well, sleep well and feel well even when the people you are trying to help cannot. Guilt and not caring for yourself doesn't help them. In fact, the opposite. 

You Can Only Help So Much

To some degree, humanitarian work istrauma (and journalism too). You are first responders and you'll witness in some way or another the very worst of human distress, at a slight remove. However, the distance we may feel can be illusory. We are often very involved in what we might be witnessing just because of our own histories - sharing race, gender, experience, family background or whatever with our subjects. And in the end, really, we're alwaysinvolved because we're human. But as witnesses, even when you are obviously doing your best to help the people you're dealing with, there can be this terrible sense of helplessness that you can't do more. Guilt, that you can perhaps apply a bandaid but however hard you work, you can't actually make things that much better. It is important to remember that the small things we do are important, and to bear in mind that the impact we can have is relatively small, but crucial. Feeling that we are doing something useful is essential in protecting ourselves against trauma. Being professionally appreciated is also vital in this context. 

All Reactions Are Normal

Of course, any reaction we have to traumatic events is personal to us, depending on how much we might identify with the group affected, and on what we have experienced in our own lives, but it is also always normal. That is, any response, from lying on the floor screaming to numbing and staying numb, is normal. We often hold ourselves up to a higher standard of ability to bear things than 'civilians' who don't work in the field, but we are not different. We are all susceptible to horror. Someone unaffected by catastrophe would be a psychopath. You are not weak or breaking down if you have strong reactions that do not necessarily pass quickly or if you detach completely and remain detached. It would be very weird not to have a strong response to crisis. In some ways, the weird thing is the pressure to keep a happy/intrepid mask on and to deny all the loneliness, despair, addictions and burnout.  Be sure to allow yourself your reaction and understand that it may not pass without help.

Try To Talk About It

Of course, as therapists, we'd say that talking about how you feel is a good thing, but often the sense of not being able to talk, of isolation, is one of the worst symptoms of being traumatized. We feel we can't talk to family and friends because we don't want to depress them or we feel they won't understand. Trauma creates a vast distance between ourselves and others that can be hard to bridge. If your organization encourages open discussion of experience, so much the better. 

Take Your Time - Accept The Change

We can think forever about the long-term effects that being involved in violence and tragedy have on us, and I think we're always in a rush to heal, to get better immediately. But really, if you listen to stories of violence, displacement, assault, you will and should be changed forever by that. Even beginning to process these things might take a very long time. It's a question of accepting the changes in ourselves. There isn't a cure, you have to incorporate these things into the new person you've now become. But there are things that help - a long break, therapy, friendships, feeling appreciated and valued and the time it takes to accept our new selves.

Take It Seriously

It sounds obvious, but there is something important about taking our experiences seriously. So many people laugh off their insomnia, alcoholism, promiscuity, even depression and despair as something that doesn't matter, especially in the face of the extreme suffering of others. Allowing your own experience to matter is crucial, and this includes feeling valued at work. Feeling that helping in these situations really does matter and that someone cares about you and values what you do. It's so easy to lose the sense that our own well-being matters. But it does. 

Despair

Accumulative trauma, witnessing trauma endlessly, can lead to cynicism and despair. It's important to remember that the despair in itself is a form of PTSD. Although, of course, our surroundings contribute to our state of mind, when we are despairing, we are also projecting our inner state onto the world around us, making it seem even more hopeless. Man's inhumanity to man is soul destroying when witnessed day after day, but it is possible to recover to some degree and to see things slightly differently. Whilst we might continue to despair at war and destruction, we can regain the ability to enjoy our friends, families and surroundings. Addressing our state of mind as well as removing ourselves temporarily from the situation is essential. 

Guilt

Journalists and aid workers often experience a great deal of guilt. Guilt perhaps at asking questions, intruding and sometimes potentially even retraumatizing interviewees, but also, and much more taboo, guilt at enjoying the job. I think there is a terrible sense of underlying shame at the excitement and the love for the work, as though it's something that mustn't be discussed. Not that these aren't very important jobs, but there is enjoyment and it's important to allow for that pleasure and not feel compelled to seem pious and serious at all times or to seek disinhibition, a permission for pleasure, only in drugs, alcohol and sex. Traveling, having a sense of purpose, being appreciated and advancing in our careers are all very rewarding. That doesn't mean we're not taking the work and the suffering of some of those we encounter seriously.

Sexual Violence

Women and men in the field are often subjected to misogyny, misandry, sexual assault, aggression and actual rape. It can be extremely difficult to report as there is an expectation of impossible strength and capacity to endure. The work we do can be dangerous and sometimes we are unprotected. Sometimes we encounter people and situations that trigger past sexual trauma. 

Often we are under sexual pressure from our colleagues and feel unable to speak out. On mission we might be involved in relationships that must be kept secret from others on mission and we can't therefore report unwanted sexual behavior that might result from an initially consensual relationship.  A session with a therapist can be a good first port of call for dealing with these situations that can so easily occur in the field.

An Abusive Relationship With Work

Many of us are in abusive relationships with our workplace. Like an abusive partner, work is making us demoralized, unhappy, frightened, ashamed and unsure, as well as making us feel clingy towards it. So we might end up feeling we're nothing without the job, that we desperately need to get better at it, get appreciated by it, that we will never find anything better and that the failure to be happy in this work is ours alone. 

This is an abusive relationship with the institution you may have chosen as a replacement family, possibly a replacement for an actually abusive or neglectful family back home. If this is the case, the similarities will be particularly debilitating and all too familiar. Again, just recognising this can be useful and therapy will, of course, help.

Between Mission Stress

Okay, a bit shrinky this; people who have a war going on in their head or have tragedy of whatever kind going on their head, actually feel more comfortable in war zones, crises, natural disasters. This is because the inner world finally matches the outer world and there is a sense of relief. Ah! See! I was right all along - the whole world really is a terrifying mess. So, the breaks between missions or jobs can feel incredibly stressful and anxiety-inducing. Not only is our state of mind suddenly greatly at odds with our peaceful, prosperous surroundings, but we may also not have an apartment of our own or anywhere where we are welcomed and at rest. We might be staying with the very family we travel to avoid, or with friends who have stable lives with spouses and children when we are still single and at sea. This can be a great time to seek some intensive therapy before setting off again or to come on a Mind Field retreat to Lucca, Italy (find more info here). 

The Pressure To Marry and Have Children 

We may start out feeling like a battle babe, young, gorgeous, intrepid, fearless and invincible, and then, only a few years in, feel we are turning into the dreaded Aid Maid, single, aged, and about to retire to no home and no family. Our own families might be contributing to the pressure and we might start to feel a real sense of shame and fear. It's crucial to talk through what we want ourselves rather than to hide from the issue in work and/or alcohol and hope it will go away. We might love being single and want to remain so forever. We might long for a spouse and children but feel it would be a failure work-wise or that it is too hard to find. Clarity can be achieved in therapy, I promise!