A dear friend of mine, a capable, compassionate and responsible professional woman, thought she was going crazy after 9/11. She was not in New York on that dreadful day, nor in Washington D. C. Yet, in the weeks and months afterward, she experienced so many inexplicable and frightening symptoms that she sought therapeutic help. She had panic attacks. She felt terrified when planes flew overhead. She couldn’t get over the images of people jumping to their deaths from the Twin Towers. She grieved as if her best friend had died, even though she knew no one personally who was killed that day.
I listened to her as she processed her experience over the next several months. Sharing her perplexity, I began a voracious reading program to understand what she was going through. Eventually, it led me to study trauma, and especially PTSD (post-traumatic stress disorder). Years later, in my inaugural lecture at Princeton Seminary, “Bearing the Unbearable: Trauma, Gospel, and Pastoral Care,” I had finally discovered the answers I was looking for. My friend suffered from symptoms of post-traumatic stress. This article is an excerpt from that lecture, which opens my book of the same name: Bearing the Unbearable: Trauma, Gospel and Pastoral Care (Eerdmans, 2015).
In their first attempt to capture the essence of PTSD, psychiatrists described traumatic events as lying “outside the range of usual human experience” (Judith Herman, Trauma and Recovery: The Aftermath of Violence – from Domestic Abuse to Political Terror [Basic Books, 1997], 33), a definition that proved untenable since traumatic incidents of one kind or another are quite common. As a psychiatrist, Herman writes: “Traumatic events are extraordinary, not because they occur rarely, but rather because they overwhelm the ordinary human adaptations to life” (33). In fact, a simple, thumbnail definition of trauma might be “an inescapably stressful event that overwhelms people’s coping mechanisms” (Bessel A. van der Kolk, Alexander C. McFarlane, and Lars Weisaeth, eds., Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body, and Society [Guilford, 2006], 279). When people face “intense fear, helplessness, loss of control, and the threat of annihilation” (N. C. Andreasen, “Posttraumatic Stress Disorder,” in Comprehensive Textbook of Psychiatry, 4th ed., eds. H. I. Kaplan and B. J. Sadock [Williams and Wilkins, 1985], 918–24, quoted in Herman, 33), and when these feelings persist for more than a month, PTSD becomes the chosen diagnosis. It is important to note, however, that witnesses to horrific events are also vulnerable to trauma. Watching helplessly as a loved one dies, seeing the Twin Towers fall to the earth, or listening in fear as one’s mother or sibling gets beaten – such events can also trigger a traumatic reaction (see Kaethe Weingarten, Common Shock: Witnessing Violence Everyday (New American Library, 2003); idem, “Witnessing the Effects of Political Violence in Families: Mechanisms of Intergenerational Transmission and Clinical Interventions,” Journal of Marital and Family Therapy 30, no. 1 : 45-59).
The subjective experience of feeling overwhelmed uniquely characterizes trauma and differentiates it from those situations that are experienced, perhaps, as exceptionally stressful but not as traumatic. Peter Levine elaborates: “Traumatized people . . . are unable to overcome the anxiety of their experience. They remain overwhelmed by the event, defeated and terrified. Virtually imprisoned by their fear, they are unable to re-engage in life. Others who experience similar events may have no enduring symptoms at all. . . . No matter how frightening an event may seem, not everyone who experiences it will be traumatized” (Waking the Tiger: Healing Trauma [North Atlantic Books, 1997], 28). The imponderable factor here is that the nature of the triggering event in and of itself does not guarantee a traumatic reaction. One person may experience the event as traumatic while her neighbor, friend, or daughter having the exact same experience may find it stressful, but not traumatic. This fact remains completely inexplicable until we realize that none of us ever actually has the exact same experience because our minds organize our experiences in a completely idiosyncratic way. Its meaning will be different for each person because our way of making narrative sense of our lives is utterly unique. Thus, feeling overwhelmed or immobilized is a variable that cannot be predicted by either the nature, magnitude or intensity of the triggering event. “Consequently,” writes Carolyn Yoder, “a traumatic reaction needs to be treated as valid, regardless of how the event that induced it appears to anyone else” (The Little Book of Trauma Healing [Good Books, 2005], 10–11; emphasis original).
This point is fundamental to competent pastoral care. Time and again, one hears people minimizing or discounting the anguish of others, essentially encouraging them to “get over it.” Wanting those they love to be whole, they try to encourage them by rationally explaining why they should not be upset by so small a thing. Yet there is little that so completely obstructs the healing process as having someone offer the free advice to “get over it” or “put it behind” them. While such defense mechanisms – denial and minimization – on the part of friends or caregivers are understandable as human reactions to pain in those they love, they only injure the traumatized further, perhaps to the point of shaming them into silence and truly unbearable isolation.
Yet, why aren’t they able simply to “get over it”? The various symptoms of post-traumatic stress have been aptly summarized by Herman, as hyperarousal, intrusion, and constriction. “Hyperarousal reflects the persistent expectation of danger; intrusion reflects the indelible imprint of the traumatic moment; constriction reflects the numbing response of surrender” (35). While each symptom originates in the triggering event itself, they all have an afterlife in the person’s unfolding post-trauma history. Any kind of physical or emotional shock has the potential to set certain physiological responses in motion: one’s heart beating faster, difficulty in breathing, rising blood pressure, and the constriction of one’s stomach. One’s thoughts may begin to race and the skin may become cold. These responses all stem from the autonomic nervous system putting the body on high alert in response to a perception of threat. The release of hormones mobilizes the body for fight or flight. When neither fight nor flight seem possible, the physiological response of the body is to freeze (Babette Rothschild, The Body Remembers [Norton, 2000], 8).
In the freeze response, “the victim of trauma enters an altered reality. Time slows down and there is no fear or pain. In this state, if harm or death do occur, the pain is not felt as intensely” (Rothschild, 10). There is a notable shift in consciousness, in which there is a subjective sense of detachment. Victims of sexual assault, for instance, sometimes speak of “leaving their body” and watching themselves from another point in the room, standing next to the bed or looking down from the ceiling (Herman, 43). Like the fight-or-flight response, freezing is also heralded by a flood of hormones. The capacity of the mind to dissociate may reduce the immediate pain and horror of the event, but it does so at a high cost. Studies now demonstrate that “people who enter a dissociative state at the time of the traumatic event are among those most likely to develop long-lasting PTSD” (Herman, 239).
During a traumatic ordeal, the intense hyperarousal of the emotions often “interfere[s] with proper information processing and the storage of information in narrative (explicit) memory” (van der Kolk, McFarlane, and Weisaeth, 286). Memory of the trauma is often fragmented; it is not organized in a linear, narrative fashion as normal memories are. Instead, certain features associated with sensory data are vividly remembered such as a particular smell, sound, image, or color. If a dog was barking when the person was assaulted, for instance, the sound of a barking dog might evoke feelings of terror or rage, yet strangely unaccompanied by an explicit memory of the assault. Or the memory of the assault may be explicit, yet strangely dissociated from the accompanying emotions. Such intrusive memories can be quite distressing, as aspects of the traumatic event are replayed in the mind over and over again, but without the full picture, without the experience of “normal memory” that enables a coherent sense of self-understanding.
The hyperarousal of the nervous system keeps persons on a kind of “permanent alert,” where they may startle easily and sleep poorly. Subject to nightmares and intrusive flashbacks, they may begin to circumscribe their world to avoid anything that might re-trigger the feelings of helplessness, rage, fear, grief, panic, and shame associated with the event. Suddenly, one is shaking and sweating in response to an ordinary everyday event. Yet, knowing that one’s response is out of proportion to what triggered it only increases a sense of powerlessness, anxiety, and shame. Because such experiences of intrusion are so frightening and because survivors can make little rational sense of them, they often do whatever they can to avoid these states or to deaden the pain by numbing out in some way.
Healing begins as the traumatized begin to piece together a coherent narrative, creating a web of meaning around unspeakable events while remaining fully connected emotionally both to themselves and to their listener. It takes courage even to begin such a conversation. None of this can happen apart from the lively presence of a caring other. Who is there that can bear the anguish of such a narrative, without minimizing or denying it, without giving advice or offering strategies to overcome it? Who can listen without offering empty platitudes or switching the focus to a similar story of their own? Who has the wisdom to refrain from asking intrusive questions prompted by their own anxiety, allowing the traumatized space to tell their story in their own way at their own pace? Who can offer a compassionate, caring presence, free of pity or sympathy, free of judgment, praise or blame?
Trauma survivors need to choose life over death, not once but many times, reaching out with the fragile hope that the trauma can be healed or transformed, that the pain will abate, or that some kind of normalcy will return. Each person needs the love, support, respect, and understanding of caring others. Those who grow through and beyond trauma do so in part by forging a spiritual framework for what is called post-traumatic growth. Not knowing if or how they will come out, they nevertheless are freed to take steps toward greater and greater freedom.
Severe emotional pain cannot be endured if it does not have a relational home, someone to hold what cannot be borne. Ministers of the gospel who are rooted and grounded in the love of God provide just such a relational home for all those who groan for the redemption of the world. They offer a steady, sturdy, compassionate, and loving witness to all who have suffered trauma. Insofar as they participate in Christ’s own compassion, they become witnesses to and mediators of Christ’s miraculous grace. By reclaiming the essential practices of our faith – compassionate witnessing, communal lament, and public worship – we “enable people to continue to love God in the face of evil and suffering and in so doing to prevent tragic suffering from becoming evil” (John Swinton, Raging with Compassion: Pastoral Responses to the Problem of Evil [Eerdmans, 2007], 85). As Swinton writes, “Loving God does not take away the pain that [trauma] inflicts, but it does transform it” (75). May God work out our salvation by bearing what cannot be borne, by transforming our mourning into longing, our longing into lament, our lament into hope, and, through the redemption of this beloved world, our hope into joy.
[Excerpted and adapted from Deborah van Deusen Hunsinger, “Bearing the Unbearable: Trauma, Gospel and Pastoral Care,” Theology Today, 68, no. 1 (2011): 8-25.]