Suffering breaks our world.
Like a tree struck by lightening —splintered, shaken, denuded
Our world is broken by suffering, and we will never be the same
In just the past few months, we have witnessed two major hurricanes
in the Gulf States and now a massive earthquake in India, Pakistan
and Afghanistan. Thousands of people have been killed, others have
been left homeless without possessions, towns and cities. The
massive evacuation of people in anticipation of Katrina and Rita in
Alabama, Louisiana, Mississippi and Texas disrupted the lives of
thousands of residents. People were often given little warning when
told to evacuate. They left homes, pets and possessions behind and
put lives and businesses on hold to avoid the path of these natural
disasters. Some returned to intact homes, others to shambles, rubble
or debris. Hurricane and earthquake survivors, witnesses and
evacuees have been left dazed, tired, angry, confused and
devastated. Their lives have been shattered, like the tree struck by
lightening, and they may never be the same again.
Natural traumatic events—hurricanes, fires, earthquakes, tsunamis,
tornadoes and floods—are strong reminders of how vulnerable we are
to the powerful unexpected forces of nature. Whether the loss of a
home, or the loss of a loved one, sudden traumatic events shatter a
person's world, destroy what was once familiar and upset the normal
sense of safety and stability. Viewing images of destruction,
waiting and worrying about safety of family and friends in these
areas, have left many witnesses, observers and others feeling shaken
and unsure. Survivors are left splintered, shaken and denuded.
Equally damaging has been the result on the overall health and well
being of survivors to these disasters. The emotional impact of a
traumatic event may be felt for years, and for many whom have lost
everything—a lifetime. This article provides survivors and
professionals who may be treating survivors with information to
understand traumatic events, the resulting normal responses and
coping strategies to start restoring their health, so disrupted by
these unexpected events.
Understanding Traumatic Events
A traumatic event is "an
experience that causes physical, emotional, psychological distress,
or harm," (1) or "an event, or series of events, that causes
moderate to severe stress reactions." They are characterized by a
sense of horror, helplessness, serious injury, or the threat of
serious injury or death. (2) A traumatic event is perceived and
experienced as threat to one's safety or stability. It may involve
experiences, changes or emotions, such as: physical injury or
illness, separation from parents (perceived abandonment), death of a
friend, family member, or pet, violence of war, terrorism or mass
disaster, divorce, loss of trust, a move to a new location,
hospitalization, anxiety, fear or pain. (1)
Devastating, natural trauma—hurricanes, earthquakes, fires and
floods—can significantly impact a person's overall health and
wellness. (3) The effects of a natural disaster can be long lasting.
Traumatic events affect those who have been directly affected by
suffering injuries or loss(es) (primary survivors). They can also
affect people indirectly, those who have witnessed the events either
firsthand or on television (secondary survivors). Additionally
rescue workers, emergency and medical personnel, counselors, relief
work volunteers, chaplains, friends and relatives of victims who
have been involved may also be impacted by the traumatic event as
Focusing on the Basics of Coping
When helping traumatic event survivors, their physical and
safety needs must be addressed first. Surviving the first 72 hours
can be difficult and chaotic. Survivors may need to be reminded to
simply care for themselves and attend to the basic survival needs of
the body. Focusing on the basic necessities—personal safety, basic
health needs, eating and sleeping—can help to re-establish some
sense of control, in coping with events that may been beyond
anyone's control. (4,5)
Initially, survivors need to:
1. Take it one day at a time.
2. Eat a well balanced diet.
3. Drink plenty of water.
4. Avoid using excess alcohol, medications or drugs to mask the
5. Try to keep up basic hygiene. Remember basic grooming and
6. Get enough sleep or enough rest.
7. Get some kind of exercise. Even walking can help relieve stress
8. If at all possible try and maintain some type of a normal
routine, such as sleeping and eating at your regular times.
9. Talk to others, especially those who have lived through and
survived similar experiences.
10.Remember healthy coping strategies you have used to survive past
challenges. Draw upon these inner strengths and skills again.
More Suggestions for Living Through a Traumatic Experience
After tending to the basics necessities, survivors can focus on
a bit more. Additional suggestions for coping during traumatic times
are found in the table below. They are developed from Dr. Mark
Lerner, clinical psychologist and traumatic stress consultant and
President of the American Academy of Experts in Traumatic Stress.
Common Normal Responses Following a Traumatic Event
The recent series of natural disasters have served as powerful
reminders that we cannot control the events in our lives. We can,
however, control how we will respond in difficult times and choose
to view traumatic events. Gaining knowledge and understanding the
common responses that occur following a traumatic event can return a
sense of control over the chaos and seemingly random occurrences
that result in the aftermath of a natural disaster.
The stress reactions and grief
responses that follow a traumatic event are normal and very common.
Many survivors have lost loved ones, their homes and worldly
possessions, experiencing multiple traumas and multiple losses.
Traumatic events impact physical,
emotional, psychological, behavioral, social, spiritual,
environmental and financial well being, disrupting the survivor's
normal balanced state of wellness. (3,5) Grief is the normal
reaction to loss. Grieving is the process a person goes through
while restoring the balance to his or her health and life.
Some of the common reactions that occur include fear, anxiety,
numbness, sadness, depression, anger and rage. Other reactions
Negative view of the world
Impatience or irritability,
Startling with loud noises
Changes in appetite—eating too
much or not being hungry
Difficulty in school
Wanting to be alone more often
than usual, or not wanting to be alone at all
Re-experiencing the trauma—in
daymares, nightmares or flashbacks
Increased use of alcohol/drugs
to cope with traumatic event, impairing recovery
Tearful at unexpected moments,
crying more easily or wanting to cry all the time
Avoidance of situations that
remind the survivor of trauma—places, time of day
Loss of interest in previous
Plans for the future no longer
Common physical responses include
nausea, diarrhea, stomachache, headache, dizziness, rapid heart
rate, lightheadedness, allergies, rashes, grinding of teeth,
increased colds and flu-like symptoms.(2, 7)
Understanding the normal responses that may result following a
traumatic event can help survivors realize that certain responses
may even be expected; they are normal reactions to a major loss.
It helps survivors to know that
they are not “losing it” or “going crazy,” rather what they are
experiencing are normal responses to an abnormal event. Survivors
need to take care of themselves and understand that these normal
responses and feelings are their body's way of coping with a major
life-altering event. This knowledge can make physical and emotional
responses less disturbing and overwhelming. (3,4)
When to Seek More Support
Most people who have been directly involved with a painful,
extraordinary stressful, traumatic event will be affected in some
way. Many will require some form of assistance, whether financial,
environmental, physical, emotional or psychological. How a survivor
reacts to a traumatic event depends on that person's perception of
the events, his/her previous experiences with prior challenges or
traumas, his/her coping abilities and the level of available
In general, the intense physical and emotional responses start to
lessen within two weeks and often disappear within four to six weeks
as life continues and the survivor's attention becomes focused on
Many people feel better within
three months after the event, but others recover more slowly, and
some do not recover without help. Much depends on the survivor's
coping skills, prior state and the nature and the extent of the
losses sustained. Someone who has experienced multiple major losses
e.g. loss of home or possessions, death of a loved one or multiple
traumas may take longer to recover. Research indicates that 20-30%
of persons directly affected by a major traumatic event will require
some type of long-term emotional support such as counseling. (2,7)
Any trauma survivor feeling or
showing any of the following symptoms should seek professional help.
Prolonged agitation or anxiety
Depression or extreme
Impaired daily activities or
Suicidal thoughts or ideation
Prolonged, inhibited or absent
Extreme physiologic or
Substance abuse – alcohol or
Various supportive resources that
survivors may find helpful include: emergency response teams,
counselors, social workers, physicians, nurses, healthcare
professionals, clergy, therapists, support groups and leaders,
mental health professionals and other survivors.
Helping the Survivors
The Center for Disease Control’s Emergency Preparedness &
Response Disaster Mental Health Resources offers ways for healthcare
providers to address the emotional needs of survivors and help them
cope with the traumatic event: (2)
Identify concrete needs and
attempt to help. Traumatized persons are often preoccupied with
concrete needs (e.g., How do I know if my friends made it to the
Keep to their usual routine.
Help identify ways to relax.
Face situations, people and
places that remind them of the traumatic event— not to shy away.
Take the time to resolve
day-to-day conflicts so they do not build up and add to their
Identify support sources,
i.e., family and friends. Encourage talking about their
experiences and feelings with friends, family, or other support
networks (clergy and community centers).
Making Sense of Loss & Picking
up the Pieces
Trying to make sense of or find meaning sudden catastrophic
losses can be difficult. Natural disasters such as hurricanes Rita
and Katrina, the Asian earthquake, or last Christmas' tsunami are
beyond anyone's control; they are reminders of how susceptible we
are to the whims of nature. Natural disasters cause sudden,
devastating, insensible losses that cannot be explained. Witnesses
are left with the realization that life is not always fair and that
sometimes bad things happen to good people.
We are left asking the poignant
It is human nature to want to answer the questions "Why?" "Why me?"
and "Why did this happen?" yet it may be impossible to ever find an
answer. Asking "Why" may be counterproductive, especially when
working on recovering and rebuilding. Perhaps the more worthwhile
question to ask is, "How do I pick up the pieces and go on living as
meaningfully as possible?"
Picking up the pieces of a shattered life and finding ways to keep
on living is a challenge. Many survivors discover an internal core
of strength, others rely on their faith, and still others cope by
making sense of or finding personal meaning in the events. They view
the event as a chance to be reborn, a turning point or a wake-up
call in their life.
Realizing that Life Goes On
Dr. Elisabeth Kübler-Ross said of mourning, that "it usually
ends when people realize that they can live again, that they can
concentrate their energies on their lives as a whole…". In time
survivors come to cope with the difficulties and the challenges,
integrate the loss, and begin to rebuild a new life—a life forever
change by the events. Integrating traumatic events into a new life
involves giving up on old dreams and not spending a lifetime
mourning what might have been. Survivors learn to accept what their
life is now.
The destruction caused in a few
hours by hurricanes Katrina and Rita or the Asian earthquake may
take years to repair. Yet in the midst of the destruction there are
signs of life. Les Brown once offered the wise words, "Change is
difficult but often essential to survival."
Although the setbacks from Rita
were difficult, residents of these states are changing in order to
survive. They are living by the words "Laissez les bons temps rouler,"
"The good times will roll again."
Slowly, survivors start to live again. In time, they begin living a
new life, believing that life is worth living and that most of all,
despite tragedy...life goes on.
Things You Can Do
You're Living Through A Traumatic Experience
action to ensure your physical safety and the safety of
others. If it’s possible, remove yourself from the
event/scene in order to avoid further traumatic exposure.
||Traumatic stress may
compromise your ability to think clearly. If you find it
difficult to concentrate when someone is speaking to you,
focus on the specific words they are saying.
Work to actively listen. Slow down the conversation
and repeat what you have just heard.
acute medical needs (e.g., if
you’re having difficulty breathing, experiencing chest pains
or palpitations, seek immediate medical attention).
||Don’t make important
decisions when you’re feeling overwhelmed. Allow trusted
family members or friends to assist you with necessary
||Find a safe
place that offers shelter, water, food and sanitation.
||If stress is causing you to
react physically, use controlled breathing techniques to
stabilize yourself. Take a slow deep breath by inhaling
through your nose and then exhale slowly through your mouth.
Upon exhalation, think the words “relax,” or “let go.”
Repeat this process.
||Become aware of
how the event is affecting you (i.e., your feelings,
thoughts, actions; your physical and spiritual reactions).
||Realize that repetitive
thinking and sleep difficulties are normal reactions. Don’t
fight the sleep difficulty. Try the following: Eliminate
caffeine for 4 hours prior to your bedtime, create the best
sleep environment you can, consider taking a few moments
before turning out the lights to write down your thoughts,
thus emptying your mind.
||Know that your
reactions are normal responses to an abnormal event. You are
not “losing it” or “going crazy.”
||Give yourself permission to
rest, relax and engage in non-threatening activity. Read,
listen to music, consider taking a warm bath, etc.
||Speak with your
physician or healthcare provider and make him/her aware of
what has happened to you.
||Physical exercise may help to
dissipate the stress energy that has been generated by your
experience. Take a walk, ride a bike, or swim.
||Be aware of how
you’re holding up when there are
children around you. Children will take their cues from the
adults around them.
||Create a journal. Writing
about your experience may help to expose yourself to painful
thoughts and feelings and, ultimately, enable you to
assimilate your experience.
||Try to obtain
information. Knowing the facts about what has happened will
help you to keep functioning.
||If you find that your
experience is too powerful, allow yourself the advantage of
professional and/or spiritual guidance, support and
surround yourself with family and loved ones. Realize that
the event is likely affecting them, too.
||Try to maintain your
schedule. Traumatic events will disrupt the sense of
normalcy. We are all creatures of habit. By maintaining our
routines, we can maintain a sense of control at a time when
circumstances may lead us to feel a loss of control.
||Tell your story.
And, allow yourself to feel. It’s okay
not to be okay during a traumatic experience.
||Crises present opportunities.
Cultivate a mission and purpose. Seize the energy from your
experience and use it to propel you to set realistic goals,
make decisions and take action.
experience a desire to withdraw and isolate, causing a
strain on significant others. Resist the urge to shut down
and retreat into your own world.
1. Medline Plus. 2004. Medical Encyclopedia: Traumatic events.
Available at: http://www.nlm.nih.gov/medlineplus/ ency/article/001924.htm
2. CDC. 2003. Coping With a Traumatic Event: Information for Health
Professionals. Emergency Preparedness & Response. Available at:
3. Stebnicki MA. 2002. The Psychological Preparation for
Extraordinary Stressful and Traumatic Events. East Carolina
University Off of Enviro Health/Safety. Available at: http://www.ecu.edu/oehs/EmergencyProcedures/
4. Dyer KA. 2002. Dealing with Sudden, Accidental or Traumatic
Death. Basics on Coping for the Survivor. Available at: http://www.journeyofhearts.org/jofh/grief/accident2
5. Dyer KA. 2004. Enhancing Well Being by Understanding Grief and
Taking a Loss History. Medical Wellness Journal. At: http://www.medicalwellnessassociation.com/docs/
6. Lerner MD. 2005. 21 Things You Can Do While You're Living Through
a Traumatic Experience. Available at: http://www.aaets.org/column5.htm
7. Dyer KA. 2001. Health Concerns for Witnesses to the
Events. Available at: http://www.journeyofhearts.org
8. Lerner MD. 2005. How Can We Help Grieving Individuals
in the Wake of Hurricanes Rita and Katrina? Available at:
Emergency Preparedness Resources
1. The Department of Homeland Security: http:// www.ready.gov/index.html
Includes information for putting together a disaster kit of
emergency supplies and creating a family plan.
2. Federal Emergency Management Agency: http:// www.fema.gov/preparedness/community_prepare.shtm
Includes Community and Family Preparedness
3. Red Cross: http://www.redcross.org/services/
Includes Disaster Services and Disaster Safety.
4. Hurricane Awareness: http://www.redcross.org/news/ ds/0305hurricane/index.html
5. CDC Emergency Preparedness & Response Site: http://
Includes various resources for coping with different agents,
diseases and other threats.
6. San Francisco, Office of Emergency Services and Homeland
Disaster Mental Health Resources
1. CDC Emergency Preparedness & Response Site: http://
Includes an extensive section on Disaster Mental Health.
2. The American Academy of Experts in Traumatic Stress: http://www.aaets.org
3. Acute Traumatic Stress Management: http://www.atsm.org