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Understanding Trauma
By Sushama Kirtikar -

Wave upon wave of sickening numbers kept bombarding our senses as the tsunami death toll rose ominously. Incomprehensible tragedy headlines splayed across newspapers. We all felt the urge to help: but how? Physical, material, edible, financial, medical, emotional and psychological help are some of the ways we can be spurred into action.

I would like to help facilitate better understanding of trauma. There are three types of trauma. Short-term traumatic events include natural disasters (hurricanes, tsunamis, earthquakes, etc.), accidental disasters (car, train, air crashes, fires, etc.), and intentional human design (bombing, shooting, terrorist attack, assault, etc). Long-term traumatic events are prolonged, repeated traumas, which include natural disasters (chronic illness, aftershocks), accidental disasters (nuclear accident, toxic spills) and intentional human design (POW, hostage taking, battered spouse, childhood abuse, refugees, 9/11 survivors etc). Vicarious exposure is secondary traumatization (witnesses of a disaster, war veterans, their spouses and children, emergency personnel, relief workers).

There are three levels of trauma. Type I trauma refers to a single event, short term, unexpected, with vivid and complete memories. Type II trauma refers to multiple events, long term, repeated, anticipated, with fuzzy and variable memories. Type III trauma refers to multiple events, violent and beginning at an early age, often with repressed memories. Prognosis is brighter for the first one compared to the latter two, which require intensive recovery work.

As you can see the recent tsunami falls under all categories, with threats of aftershocks, hunger, homelessness, cholera, dysentery, looting, human trafficking in Aceh and gang rapes in refugee camps in Sri Lanka compounding the adverse effects of this unfathomable adversity. Majority of the survivors of the catastrophe are guaranteed to experience post-traumatic stress symptoms in some form or the other.

One cluster of symptoms refers to reexperiencing the events (recurrent, intrusive thoughts, nightmares, reliving the experience, flashbacks, psychological distress and physiological reactivity to external/internal cues). A second cluster refers to avoidance of stimuli (avoiding thoughts, feelings, activities, people, places, unable to recall important aspects of the trauma, diminished interest, feeling detached from others, restricted range of emotions, sense of foreshortened future). A third cluster refers to hypersarousal (difficulty falling asleep, irritability or outbursts of anger, lack of concentration, hypervigilance, exaggerated startle response).

Belief systems are mangled and basic assumptions are shattered. “The Bangkok Post” is already alluding to survivor’s guilt accompanied by suicide risk in Phuket. “Why did I live?” is a belief in rational meaning. “Why me?” is a belief in world order, predictability and control. “It can’t happen to me” is a belief in invulnerability. “Could we have prevented it somehow?” is characteristic self-blame. “I deserved it/I did not deserve it” is a belief in self-unworthiness/worthiness.

It is said that 50 percent of those who suffer from post-traumatic stress disorder (PTSD) will continue to suffer from it for decades later if untreated. This makes treatment imperative now. The earlier the intervention, the better will be the prognosis, as in any physical illness. Just because mental distress or illness is not visible to the eye, it tends to get overlooked, dismissed and minimized. The urgency of the matter cannot be over stressed. Obviously, basic needs of survival, safety, sustenance and physical health come first. However, on the heels of the same, the psychological needs of the survivors have to be met as soon as possible. Permanent scars have already been imprinted on their psyche, no doubt, but these do not have to develop scar tissue that will impede healthy living.

We are all equally at risk of secondary traumatization from daily exposure to vivid audio-visual stimuli despite the fact that they remain two-dimensional for most of us. How often have you heard, “Turn off the TV! I can’t take it any more?” If you have not experienced any pounding of the heart, clammy palms, pressure behind the ears, a knot in the stomach, or jelly knees, then you are still numbed by shock and disbelief. Let us remain humble in the face of nature’s glory and power.

Sushama Kirtikar, a licensed mental health counselor, can be reached at (813) 264-7114 or (727) 586-0626, or e-mail at

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