When I saw the pictures of Monday’s tragedy in Boston, my heart went out to all the people in the race – from the runners, to their families and friends, and of course the residents of Boston – all gathered for what should have been a day of celebration and accomplishment.
But one person in particular caught my eye: someone in the special jacket that the marathon coordinators use to identify the medical staff on site.
Given the nature of the bomb, the quick response of the medical staff probably saved many lives.
My late partner, Christine Huda, co-founder of NICABM, served as a nurse at several of the Boston marathons when she was alive.
Her service always inspired me, and in light of this week’s events, it got me thinking about the critical role that practitioners play when treating a person who’s experienced trauma.
One of the major indicators of PTSD is a sense of feeling distant or cut off from others.
But according to Peter Levine, PhD, there are practical ways to minimize the onset of future traumatic symptoms.
When Peter and I were discussing what an emergency room nurse or physician might do to help a patient who was shutting down after a trauma, he shared this quick strategy (paraphrased from our conversation).
I cannot understate the importance of making social connections after a trauma. Just by making that contact – human to human – we can change the course of healing.
While I shared this practical application from Peter Levine, the importance of social support for people who’ve experienced trauma comes up in countless webinars.
Social support, and even ritual, are essential not just for individuals but for entire communities.
While most of us are not first responders with the opportunity to intervene at the individual level, we can offer our thoughts and prayers for the people affected by the bombing.
How have you coped with the complex feelings that arise after tragedy? We hope you’re able to find healing through the closeness and togetherness of friends, family, and community. Please leave your thoughts in the comments below.
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The trauma healing webinar is very enlightening, educating, as well as disheartening to me.
As a person who experienced severe traumas in childhood, as well as adulthood, I almost feel hopeless, despite all the work I’ve done to heal. Still feel that some of it is there, and keeping me stuck at times.
But the worst part for me is, all that I’m learning about the next generation, and some of the mistakes I’m sure I made as a parent. Although I’ve done my best, and my kids who are in their 40th turned out great, I feel very guilty and wish I had all this knowledge when I was a young parent.
I think we shouldn’t become parents before the age of 40. I’m concerned about our future generations, and how they are brought up. Abused, neglected, and wrongly diagnosed by their schools, care takers, and environment.
thinking of the 19 year old prisoner…..he might very well die if not feeling support from care givers, and we don’t want that to happen.
i appreciate all the comments here. part of what i find so helpful is the recognition of the shared humanity piece where we all recognize the suffering in ourselves and others, knowing we are not alone in our experience though suffering wears many faces and thus we are not separate. we take turns holding out our hands and accepting hands held out. in this world, knowing others care and have survived similar events is healing. the gift of online connection is we can share information and connect however also real life presence: the simple touch, the simple hug and the simple eye to eye in “i see you, i am here” holds immense power. may grace surround all who are suffering…
Hi Ruth,
Just before reading your message, I got an e-mail from my best friend in elementary – high school with whom I regained contact recently because of an upcoming high school reunion. I haven’t been able to send her family photos because of a serious (though not life-threatening) medical crisis with my daughter. My friend said she “wouldn’t bother me” during this difficult time and I just replied to her that I wanted her to “bother” me because it helps to hear from people who care. So, I completely echo your and Peter’s views.
Several friends are marathon runners. I see them comforting and supporting one another through social media. Their spirit and determination are powerful. It is likely that anyone who has PTSD will find their symptoms are activated simply by watching events on the media. I would encourage them to seek support.
Dear Ruth,
This Boston trauma hit home with me. I’ve run the marathon 3 times and understand that for the runners the pure elation and exhaustion at the finish line is enough to handle emotionally. Throw in this unfortunate bombing event and suddenly the lives of family, friends, fans, you name it become a part of the entire “Boston experience”, which for many involves their own personal story on how they got there. At Boston it’s more than just the marathon. My Boston experience was way beyond the the race itself.
This year’s tragic bombing brought up a similar traumatic experience that came for me at an Ironman race in Coeur de’ Lane, Idaho the first year they had the race in that small Idaho town. I was a seasoned triathlete, well experienced and trained for the event, however that particular day the heat at 95 degrees got the best of me. I did everything right in terms of nutrition to sustain a decent finish which I did so admirably, yet still ended up unconscious like many after the event (yes, no one tells you this part) and was unconscious for hours after the race, hospitalized and traumatized from a near death experience resulting from an event I hoped to be a life enhancing one . I spent a horrendous night in the hospital regaining my basic human biological existence.
Why I’m writing this (finally, after ten years) is that yes, I agree that touch is SO important, I had IV’s pumped in me (6 liters of fluid), and although that touch was so sterile and medical I remember the care. More importantly, what I’ll never forget that brought me the comfort I needed were these words once I was moved from the medical tent to the ER: “Connie, you’re in an ambulance”. I know that’s not very flowery at all, but 1. I heard my name. 2. Even while unconscious, I could grasp where I was and 3. Ambulance represented safety. It sounds so basic, but even if I was conscious, hearing my name and knowing someone was taking me to a safe place proved to alleviate so much anxiety and provided a tremendous amount of comfort at the time.
I’ve never written about this experience until now. I’m sad that a lifetime goal of mine turned out to be tragic and almost killed me. I imagine that’s how it is for many of these marathoners, their families, and those supporting them. It makes me so sad. In relation to immediately assisting some of these people, all I can add is that the simple act of 1. Hearing their name, and 2. Letting them know they are safe in the moment is HUGE in bringing comfort and support.
Thanks Connie for telling your story. And for the good advice.
when I lived on a busy highway I attended some severely injured accident victims. One young woman had been thrown through the windshield and was laying on the side of the road. She kept repeating “i’m going to die” incessantly and was unaware of my presence. The driver was not badly injured so I asked him for her name. Calling her by name broke her deadly mantra and she responded to my touch and reassurance that she was being cared for and that more help was on the way. There is power in the naming and being so confirmed is one way of saying I hear you.
I am validated to read this, Ruth. This truth has long been understood in the psych world. As I read this I am particularly responding to the line “…how important it is to make social connections after trauma.” In your example we read about a 1:1 social connection of presence, stability and reassurance. I am extrapolating this to a community level – more complex, but related. In the first days after Hurricane Katrina hit my home area I volunteer with the Red Cross at head quarters 2 blocks from my home. I was sent to work at a shelter in a nearby town that turned out to be an unofficial Red Cross shelter set up by that town and the Red Cross as an immediate provisional measure. We had no satellite communication (standard for official RC sites). For weeks the communication infrastructure was down – hence, we were truly an outpost. The experience was a striking lesson in how normal social contact is essential to healing. As the boats brought survivors to the local emergency room they were shuttled to this shelter – a neighborhood community center. Everyone arrive in shock that naturally gave way to fear (many never moved from shock). At first the cots were 7′ feet apart, then 5′ and then 3′. You can imagine the evolving tension of fear and distrust as more and more strangers of various social and racial groups were force together after such a loss. What was beautiful was that the first responders leading this center accepted the victims’ help to support the community operations and in basic community building. As the culture of ‘can do’ established, trust between the persons of the staff and residents was seeded. We organized such simple things as a talent show, inclusive community worship, resident work groups organizing stores, expanding the taxed sewer system, etc. What I witnesses was a group of people who began to create community and support each other (not all, but many, many) who felt normalized and empowered in these social interactions. Essentially, the staff offered that calm, stable, in tact hand and eye contact that said, “you’re ok. I have faith we’ll get through this together.” In a couple of weeks residents got moving and problem solving for themselves helping each other search for family and jobs. I came to find out that this was not the Red Cross way. Infact, the leader of that shelter was reprimanded and terminated. There are apparently strict RC rules that staff give and victims receive. The RC personnel at the time were trained that staff is interchangeable, kind but impersonal. And I learned that in other shelters the residents did not have ways to community build. The faith in the victim’s resiliency is not so clearly shared. Six weeks later my first shelter was closed and we move to a newly opened school shelter blending new folks from other places. It was an RC protocol shelter. The people could only focus their energy on their victimhood and disenfranchisement. They became an angry, disempowered, stagnant population of victims. Their resiliency had melted into hostility and threatening entitlement. 2 months later, I struggled to find people who would participate in group social functions outside of their clicks and bitching sessions. Such a sad and striking difference!
As a medic, I have seen first hand how the attitude of the first responder can make a difference.
By being calm and really seeing the real person in front of you, you can reassure the person and Influence their outcome. By helping them to overcome their fear, you increase their chances for survival.
I like Peter Levine’s suggestion.
I worked in disaster recovery after hurricane Charley (2004). I also had survived that hurricane myself. My home was severely damaged. My neighbor checked in to see if we were ok. I spent the night on the pull-out couch because everything, including the beds, was soaked. That night the ceilings were coming down (no electricity, no A/c). After that terrifying night, I had breakfast at a local hospital where we were allowed to make phone calls to loved ones. I told an elderly couple, my other neighbors, that this hospital was serving dinner that night. I had dinner there as well. That hospital had also sustained considerable damage and must have called in the National Guard to help closing it down. Although all this kindnes had come my way, seeing the National Guard made me finally feel safe again.
My thanks to first-responders!!!
Always rehsirfeng to hear a rational answer.
Oklahoma City bombing has taught us valuable insights into what helps people heal after a mass trauma and profound and shocking tragedy affecting thousands of victims. As chief of staff of the downtown hospital close to the bombing site where most of the victims and families came for healing, I have witnessed nothing short of spiritual miracle. People from all walks of life showed outpouring of love,support and comfort in addition to taking care of very need the victims had. Over the next few days, weeks and months, the community continued profound commitment to help the victims and their families. The mental health professionals and doctors have spontaneously set up mental health first aid center at the basement of the hospital where hundreds of individuals came for support, comfort, clarity and direction. This has paved the path to more definitive interventions for healing and recovery and integration into normal life.
R.Murali Krishna, M.D, author, “VIBRANT: to Heal and be Whole, form India to Oklahoma City
In a traumatic situation we can use our own body to help regulate the nervous system.Offering body contact that is respectful and reassuring can help regulate the traumatised person.We have an incredible tool if we know how to use our own body to contain and provide support and reassurance either through holding hands or the person’s head or embracing the person.
After the supremely traumatic loss of my frail, 83-year-old mother to a senseless homicide, I can recall going what I would now identify as the stages of grief that Kubler-Ross wrote of. The first was a enveloping numbing and sense of unreality. Later came towering rage, depression, and a pervasive terror–a sense that there was no safe place on earth. In the midst of all this, I carried on what was necessary, dealing with police, talking to reporters, sitting with the family, making funeral arrangements. There was some comfort in action, although nothing would bring Mother back. One thing that stands out for me that provided enormous comfort was my dear aunt, who hugged me gently and said, “Well, you still have your old Aunt Ruth.” That was an act of contact–not just physical, but at a spiritual level. That was my first clue that there might be some islands of safety still remaining on the planet.
Two nervous systems that are paramount during trauma are the Sympathetic Nervous System (SNS) and the Parasympathetic Nervous System (PNS). During trauma the SNS is highly engaged and the emotional hijacking may lead to shock. Strategies to engage the PNS to as much of a degree as possible given the circumstances is critical. Other strategies including those suggested are modeling slow breathing, providing information and what will happen next (security references) , questioning the victim may provide Prefrontal Cortext stimulation and divert amygdala stimulation.
I so agree with your focus, especially modeling the slow breathing, with eye contact if possible, framing the event into time, saying what will happen next, and if possible physical contact that grounds the person. I used top do what’s called “emergency psychiatric” in a trii-county E.R. and what you say is born out in my experiences.
It’s actually beautiful, that human contact is the factor that can help a person through this trauma. So often you’ll hear EMT professionals talking to the patient: “Stay with me”….. I don’t think it’s training, but a heartfelt response. But for those who have dissociated to set up protective boundaries to protect themselves from the trauma of “losing a patient” in the ER, this training is imperative.
My children had arranged for us to spend my birthday on St. Johns, snorkeling and walking beaches. The first morning, we hurried down to the beach, my husband lagging a bit behind. We happily put on our gear and went into the calm, clear water. An hour later I was holding my dead husband in my arms, begging him to return to us. Once they took his body to be cared for elsewhere, I walked with my sons and grandchildren back to our house. How empty it seemed! Then I looked at the pale, shocked young people around me, and realised that I had to reach out to them so they would not remember this as a horror scene, but focus on the wonderful, loving grandfather who had died doing something he loved, surrounded by family. Not a bad way to go at 83. I sat with them and encouraged them to reminisce about dear Syd, and what he meant to them. Soon we were laughing over his quirky sense of humor, his delight in his grandkids. I let each of them choose something special of his. The next day we went snorkeling, “in his honor”. We left the young people there to finish the week, and we came back to my home, where the one son who had not joined us had put a notice in the paper. We had a memorial service for him. Now, when family and friends talk about him, it is positive and loving. We shared grief, love and rich memories of a life well lived. Immortality lies with the memories of those who come after. Rituals reset the path to the future.
Reaching out socially and making connection with others IS critical. So is breathing-in a gentle, full body and regulated pattern. Easy breathing eases all. It’s also tempting to grab for a drink of alcohol or pop a pill to relieve the stress and trauma. Just remember, this behavior can ultimately make things worse, both in terms of stress relief and decision making.
After such a traditionally wonderful public event becomes tragic I find I need to centre myself first to release all the personal trauma I am experiencing. after the initial shock I realize I am heading straight to blame and looking for conspiracy in all the said and unsaid details. I feel left out too as a neighbor.Who are the injured? Do I know any of these people? How can I help?
We may think that being so far away in Canada that trauma response is not necessary but as I meet people I find I am naturally bringing calm with my voice, using touch, if it is natural and easy to connect us to our hearts and I do my best to steer the conversation away from vengeful spite into a heart centred prayer for the loss and injury. I remind them that America is our neighbor and that Canadians were among the many in a world event. I think Justin Trudeau was right. The people who did this are unwell and so I also send prayers to them as well.
Trauma Management is I am afraid happening so frequently because we are a world community that these tools seem to come in use very often. I am now aware that when someone brings up disaster news in transit or in casual conversation that I am already engaged in what has become a too present experience of trauma that we all share in a world of conflict and uncertainty. I don’t know how others feel but I am using trauma tools more often than I ever did a decade ago.
This is a simple, yet significant act of connection, a hand on the forearm. It reminded me of my reading of Delores Krieger’s “Therapeutic Touch”. It is most important to know one is not alone when confronting trauma ,or in any life changing event. Thoughts and prayers are a means of connecting for all of us as well, in ways we may never understand.Thank you for your consistently challenging me with thought provoking material.
A simple gesture, a simple statement, as you suggest, is often most helpful in the moment. A wise friend passed along this advice for anyone who has experienced or learned about a tragedy: “Look for the helpers.” By focusing on those who turn toward the danger to help, those who rush in to bring aid, those who offer solace or support or solidarity, directly or indirectly, we can help moderate the shock and despair. The good that is present is very real. It can help to counterbalance shock and despair, if we notice it.
After my rape one of the EMTs sat with me and put her hand on my shoulder and said – “You’ll be okay. I’ve been through this too.” I knew she meant she had been raped. It totally calmed me down and I didn’t feel alone anymore, even though my friends sat with me also. My healing was amazing after the rape and I forgave the rapist about 3 weeks after the event. It shocked me! But using all the treatments available like EMDR, tapping etc. I was able to become a rape therapist. Good things do come from trauma. I was told that by my supervisor. He said “you will see.” And when the rapist was convicted 6 years later, I sat in the courtroom and was shaking as they pronounced his imprisonment. I had read Peter Levine’s “Waking the Tiger”, as had my children, and we all smiled as I shook, knowing I was ok!.
I so appreciate this timely reminder, article on the importance of touch. And I would like to add that one can touch another with energy from the heart just by having that intention.
Thank you, Ruth and all for the outpouring of love. I had a few family/friends that were there and came close, but fortunately were spared. Knowing they came close is frightening. Around Boston and my college campus, there have been added security, some of which created shots of anxiety through me, whereas others have comforted me. It’s a process. As a Medical Sociology major (Interactionist perspective) I’ve observed beautiful displays of community and beautiful stories of such. It’s those things that give us hope to rise above adversity.
Ruth,
This simple but profound intervention is a great technique to know and apply in these horrific situations. My previous professional career before becoming a a clinical social worker was as a registered nurse in the miilitary where the art of touch and communication is central to the healing connectioin process with our wounded warriors and their family members.
Thanks.
Ron
How true, to be there for someone, at first physically to let them feel themselves through you. A gentle contact that brings them into the present with eyes that connect with a caring and strength to support as if a long branch to hold onto while being pulled out of the quicksand until their arms and legs can begin to free and help them move forward to firm land. Thank you for sharing such potent and pertinent information.
Hi, as an art therapist, I studied how the arts can be used after natural disasters, following the big earthquake and tsunami that happened in chile on 2010. Asking creative arts therapists around the world, I concluded that the most important thing was to help create the sense of community. The connection with others. In this regard, the arts can be really helpful,because people get interested not as getting mental health help, but, they engage to play, to play with the arts, getting therapy on a more informal way.
Thanks for the series…
Never would have thunk I would find this so inndipessable.
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i am a true believer in rituals for healing as you have stated. rituals engage the psyche at the deepest level, i.e. spiritual. and true healing, i believe, occurs passed the verbal consciousness. that is why i attend journeying and drumming, sweat lodges, sundances etc. to process second hand trauma we all experience being exposed to tragedy in news or in our clients.
I have been Medical Director for an ambulance corps, and a teacher and a “dating/mating/marrying” counselor (and currently run a manufacturing company!). Ruth, I am benefiting from your NICABM series. (This one is making me look more closely at *myself*. Maybe I’ll finally deal with all my traumas…)
I don’t know if my comment on a blog, reproduced below, is more a naturalistic/realistic viewpoint about reality — or a shut-down rationalization of trauma — but I’m considering both.
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A frequent-flyer-miles travel blogger wrote a heart-felt entry about his ‘escape’ in Boston (he was an hour gone from the finish line when the bomb(s) went off).
I commented:
Humans have a weird sense of what’s risky and not risky, and we “think” (except it’s not actually thinking, it’s more hard-wired, and less reasoned, than that) about which risks we’re willing to take and which we avoid and then making up things we call reasons for it. (I’ve been reading a lot of “the Dans”: Kahnneman and Ariely, lately)
Dr. Peter Sandman has a lot of stuff on his website about risk communication which I find helpful in figuring myself out, not so much in terms of me doing risk comm. for others as doing it for myself in my own decision making. Even if there had been no bomb, and even if a bad thing had happened when you and your friend were at the finish line (say, someone mistaking an accelerator for the brake, which happens not infrequently); the hardest thing to deal with is: it really IS a random toss-up whether or not you are the human who gets hurt.
Contrary to Einstein’s wish, God DOES play dice with the world. (Or, for those of us who don’t believe there’s an old guy in a toga micro-managing our lives in their every detail: the universe is RANDOM; and randomness cannot be managed or prevented, only lived through.) Part of the joy you find in travel comes from that very randomness; however there is no guarantee that the random events will be positive. (I believe, as you seem to, that the positive ones outweigh the negative ones.)
My heart goes out to the families and friends of those killed and those maimed and injured by this dreadful act, but there is no safety in life. Take reasonable precautions and carry on. (And even though Sandman says, in *good* risk communication one ought not make these types of comparisons:) The chances of you getting hit by a plain-old bus are way, way higher than of being hurt in a bombing. The chances of being injured in an earthquake are way, way higher than being shot in a mass shooting. Chance is random; take reasonable precautions and carry on.
My husband, with whom I traveled (mostly cruising), died suddenly in 2011. I’ve had to make (and am having to make) the adjustments required by the fact of my entire “normal” life being destroyed. I’m having to create an entirely new “normal” life. This is the human condition. When I am once against financially (and emotionally) stable, I will go back to traveling (mostly cruising). Life goes on for those who do not die. Life ALWAYS goes on for those who do not die.
And life is risky, no matter where you are or go.
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Your article peflcetry shows what I needed to know, thanks!
last week,I saw in the news a little Syrian boy ,maybe 10 years old.He said:
In the beginning of the war ,I was afraid of blood,now blood is just water to me!
in the beginning of the war,I had a heart,now I’ve pulled it out of my body!
What he meant to say was that after 2 years of war,this child felt like nobody’s taking care,nobody’s listening!
Now,we all could see the bombing in Boston and how awfull it was !Many people will see their lives changed for ever!
I heard that a little child from 8 years old died!
I will keep those 2 children in my heart as a symbol for all the people young and old suffering now!
As a victim to multiple layers of different and untreated trauma experiences I can attest to the resulting sense of utter loneliness, shame/guilt and at times a sheer terror with consequent shutting down and inability to function. The body carries a lot of stress. Even a visit to a dentist who doesn’t explain new technique or is “hard” in his hands reactivates all these memory fragments.
I personally can’t afford EMDR treatment. I learn a lot from these nicamb trauma series. A simple gesture like PL suggests here indicates that someone cares deeply and that tells the patient that he/ she is seen by a another human being: Moreover, it indicates the ‘Presence’ that we speak about in mindfulness training.
Such a honest gesture in a critical moment can mean more than one can imagine for the surviving patient. And if the patient is going to die this might even be the last human contact he experiences. Such gesture opens up not only the human sphere of contact but even the spiritual one. We will die, we do not know when, and in a trauma situation as the victims of a bodily attack we just hope it is not yet, not now.
Peace.
What a powerful strategy. I am sure it did not happen, early in childhood, when I would have needed it at things I must have experienced as overwhelming awfulnesses.
At massive horrors, I cut off emotionally. The World Trace Center bombings. Etc. I remember everyone being so caught up, watching TV for days. I was totally against the horror, but on an emotional level I was distant.
I’m not like that with everyday events, including individual tragedy.
Thank you, for the article. I wonder what you mean with the “social rituals” in this sentence? “Social support, and even ritual, are essential not just for individuals but for entire communities.” Any examples? Maybe write an article on this theme?
And my prayers goes out to all affected by the bombing.
Gratitude,
Marina
After the Montreal Massacre when 14 young women were killed, I invited women who worked with women to gather. We had a very simple circle in which each woman spoke about the meaning and impact on her. Every year there has been a memorial in our community. this year there were two. There have been speakers, sharing circles, candles, flowers, videos, and always the names of the 14 women. Women 30 years younger than I now organize a ritual that has meaning for them.
Thanks for sharing this profoundly basic and healing gesture, Ruth. It reminded me of how we respond to children when they are hurt, we hold them and remind them that we are there with them. As adults we also need this so Peter’s practical example of how to be with traumatised people is just great. The Boston bombing is a stark reminder that we are all vulnerable to the uncertainties of life and when such things happen we can send our heart energy to Bostonians from wherever we are in the world. I send mine now. With love, Fiona