Post Traumatic Stress Disorder

PTSD as a Result of Witnessing the Death of a Loved One Patrice Ellis Liberty University Abstract Post Traumatic Stress Disorder or PTSD is described as a potentially debilitating mental disorder that can develop after a person is exposed to a traumatic event. These are often relived through nightmares, flashbacks, and possibly anxiety attacks. (Kanel, 2018 p.134) On a bright sunny holiday (Labor Day) here in the Bahamas in the month of June 2018, a mother along with her six young children filled with excitement and anticipation left the comfort of their home to join thousands of other Bahamians on the sidelines to watch the workers of this country march in solidarity. Little did they know that very soon after their comfortable arrival, to their preferred viewing spot tragedy would impact their lives in a way that will affect them for the rest of their sojourn here on this earth.

How do these children go on with their lives? What should be the first order of business or intervention? Is there a role for the church? How do you know when this family is at a self-manageable state? It will be interesting to revisit and see what this family dynamic looks like in one year. It is unclear how many children and adolescents develop post-traumatic stress disorder (PTSD) after trauma. My aim is to determine the incidence in trauma-exposed children and adolescents via systematic literature research. The ideal scenario would be to provide “”personalized care that is tailored to these children which will address problems that concern him or her most while introducing Jesus Christ to them.

Keywords: post-traumatic stress disorder, tragedy, mother, children, witness, Outline I. Introduction A. History of Labor Day 1. A day they’ll never forget a. Leaving home b.Positioning Themselves c. Watching and enjoying the Parade. Then it happened II. Princess Margaret Hospital A. The ambulance arrives B. The Trauma Room C.Code 999 D.Pronouncement III. Coming to terms with reality IV. Psychic Trauma V.Release and Follow up The Nature of Trauma in General “”Life is an interesting mixture of good and bad (N. C. Ellis, personal communication, 2010).

This is a quote that is often verbalized by my Senior Pastor, Bishop Neil C. Ellis. As I near the mature age of retirement, more and more, I appreciate that statement and the meaning therein. “”Trauma is the response to any event that shatters your once safe place and makes it no longer a place of refuge. It is more than a state of crisis. It is a normal reaction to abnormal events that overwhelm a person’s ability to adapt to life. Where you feel powerless and you’re thrown about like a rodeo steer. Your world turns wild, out of control and crazy (Wright, 2012, p.189). As with everything else, trauma can be categorized as mild, moderate or severe and these are determined based on a person’s makeup, how they’re wired, their personality, culture, religious beliefs, and the individual’s definition of trauma itself. The Way I Understood Trauma Prior to taking this class, I regarded trauma to be an event or something that happens in your life and at the particular time, you might be hurt, disappointed or even broken and remain in that state for a quite a while.

Those emotions might dissipate after a while; you transition eventually to a good place and you’re finally able to move on with your life. Many years later perhaps, another incident occurs; this could be in word or deed, nonrelated by no stretch of the imagination and suddenly out of nowhere, certain emotions are aroused. You wonder, where did this spin-off feeling come from? As you settle down and get to thinking about it deeply and over a period of time, you recall an incident happening some time ago and realize that these feelings were simply lying dormant and that you’re really not over that incident that occurred many years ago. My Revised Understanding Now that I have engaged in this crisis course, my comprehension and definition of trauma have slightly amended. According to Merriam-Webster, the Greek word for trauma is wound, and when we think of the word wound, we think of an injury to the body. However, again according to Merriam Webster, a wound can also be a mental or emotional blow. This is not so obvious, but when discovered, not only would you require psychological or crisis intervention you will also need an accurate understanding of the scripture to hold on to and a strong faith in Jesus Christ for encouragement and to protect yourself (Psalm, 11:1, 22:4-5, King James Version) states “”In the Lord, I take refuge.

In you, our fathers put their trust. They trusted and you delivered them. And so that you do not go under and you can remain standing, like the Bible states in (1 Corinthians15:58, KJV) “”Therefore, my beloved brethren, be ye steadfast, immovable, always abounding in the work of the Lord… I learned that trauma is indescribable and oftentimes staggering so much so that words are inadequate to describe so you try to erase it from your conscious mind. You try to go on with life as if it did not happen. Trauma when in full operation takes away a person’s sense of wellbeing, safety, and predictability (Wright, 2012, p. 213). I now know that you can experience a crisis but not necessarily be traumatized. No one is exempted and no matter your ability or coping skills to handle ordinary stresses, trauma can overwhelm all of us. According to (Wright, 2012, p. 200) “”studies have identified that there are 58 general vulnerability factors that contribute to a person becoming traumatized, but researchers are still puzzled about which responses assist a person in adapting best to a traumatic event. Let’s not forget that what’s traumatic to one person might not have the same effect on another.

Causes of Trauma in General

As previously stated, trauma can be caused by an overwhelmingly negative event that has a lasting effect on an individual’s mental and emotional state of wellbeing. The source of trauma can be physical in nature eg. natural disasters, rape, domestic violence, excessive spankings and beatings, severe illness or injury, an intrusive medical procedure, an unsafe or unstable environment, a prison stay, terrorism, or historical trauma. Psychological trauma can be experienced by the death of a loved one, friend or pet, divorce, witnessing an act of violence, moving to a new location, parental abandonment, verbal abuse, and neglect.

Detailed Nature of the Traumatic Event

Labor Day in the Bahamas as I aforementioned is a holiday that is set aside to recognize and celebrate the achievements of the workers of the country. This is usually a very exciting time and citizens lined the streets to watch the various labor unions participate in a grand march wearing the colors of their choosing under the theme and banner that best fits the slogan of the labor force that they represent. This year 2018 was by no means less in terms of promotion, organization, celebration participation, and observation. A beautiful sunny day here in the country, an excited mother of 7 children (4 adopted) as a result of a previous traumatic experience; her sister’s tragic death by the hand of her sister’s husband and watched by her sister’s 4 children, left home to go and secure their preferred space to watch the Labor Day parade. It is said that the mother (Tabitha) could not wait for the upcoming holiday and left work the day before with a level of excitement that was unprecedented and kept saying to everyone that she saw how anxious she was to expose her children to this historical event. Upon familiarizing herself with the route for the parade, she then identified where she and her children would go to secure their comfortable spot to wait for the parade.

It’s reported that Tabitha and her children waited for their favorite organization of workers to come along and decided that they would join this particular group and participate in what they regarded to be a more meaningful way. It was not too long after they joined the group and were dancing in the street, that what was anticipated, celebrated and exciting day was marred by tragedy. The brake on a parked truck on a hill that was transporting a portion of the music for the parade mysteriously was released and came rolling down, going faster by the second. The result 5fatalities. Yes, five (5) persons lost their lives including Tabitha and in this case right before her children’s eyes. The Effects of this Tragedy It will be quite a while before we begin to witness the true effects of all that this family has endured and will continue to encounter. The brutal deaths of 2 women that represented mother figures in their lives are now gone and reliving this tragedy on a daily basis are seven young children between the ages seventeen (17) and six (6) years old whose fathers are also displaced as one is incarcerated for the death of one of the women and the other is noted as a dysfunctional parent who lived in a separated state from the family home. We know at the offset, the first concern would be who would be accompanying these children from the trauma site to the hospital and support them while they await word on what appears to them, to be only an injured parent.

Then identifying an adult relative to be with them when the doctors give the prognosis . Thirdly, supporting them after they’re told and finally determining who is going to be responsible for securing these children and where they would live. Trauma sends four messages to children and the long-term effects are often times worse than the trauma itself. According to (Wright, 2012, p. 339) the messages are: your world is no longer safe, kind, predictable or trustworthy. While the experience might dissipate at some point, the internal effect of it will not. It’s a lifetime maze of working your way through. Imagine the thoughts that must be going on in their heads, the fear, the questions, just a state of confusion, questions and maybe just numbness and in the case of the very young ones, maybe no thought at all. Clueless to what all of this mean and so the older ones are almost thrust in a position of having to grow up quickly. Immediate Crisis Response Strategy How well a person comes out of a crisis is determined largely by how he or she deals with the situation, but in this case, these are children. While we want to and should pay attention to the behavior that’s being exhibited by the bereaved child, the truth is, most of them are short-lived and drop out on their own. Let’s pay more attention to how long this behavior lasts.

The time frame for an event to remain a crisis is 4-6 weeks and even without any outside intervention, the crisis state will eventually cessate, because humans cannot tolerate tension for a longer period than this. (Caplan, 1964; Janosik, 1986; Roberts, 1990; Slaikeu, 1990). Research shows that “”not all bereaved children need grief intervention, some of them manage quite well on their own (Corr & Balk, p.139). However, the approach used to talk to these children will be determined by their developmental level and their cultural norms. Most adults and children (people) take their cue from surviving adults, or persons that they regard in high esteem. For children ages 5-9, however, death may be over-generalized. They may understand death to be something that happens to others, not to themselves or their family. Children at the middle school age can comprehend death as a final event and children in high school would be able to fully grasp the meaning of death even in circumstances such as an automobile accident. (Wright, 2012, p. 376) points out that there are 11 considerations to use with grieving children. They are as follows: Give the children permission to grieve and to ask questions, be available when the child is ready to grieve, know how to respond to the child who’s asking the same question repetitively, give opportunities for playtime and creative expression, Watch your expectations and dismiss their myths. Watch for signs of fear and encourage children to continue their normal routine of play and extracurricular activities. In other words, let keep life as normal as possible and as soon as it’s feasible.

Factors necessary to cope with trauma. In a case like this one, I think we need to minimize the children access to the visual media as much and as best as possible. Media exposure can be premature and dangerous. The newspaper can be read as a means of keeping up with current events. Provide the child with opportunities for conversation and dialogue and encourage physical activity. Feed your child a healthy diet while helping them to rebuild trust and safety in all areas of their life. Crisis situations are always a great opportunity to introduce Christ to victims and others that are serving as caregivers and supporters to trauma victims in some kind of way, however, you must be sensitive to the leading of the Holy Spirit in terms of what to read /present and when to do this while ensuring that you are not short-circuiting the victims expression or feeling of grief. If the child is old enough to have a sense of God, let them know that God loves them and that he is with them. The older children can be given a verse or a list of verses to choose from and commit to memory and encouraged to repeat it daily, maybe multiple times during the day if they find it helpful. As an interventionist, my role is to assist the traumatized in their journey and to encourage them in their faith. One can become traumatizes in a split second but it’s a process to overcome being assured that God is with us and He won’t let anyone travel this journey alone (Wright, 2012, p. 236).

First and immediate intervention at the scene. I believe that the first 24-48 hours are very critical in any situation that is regarded as critical or traumatic. First responders are the first set of professionals to interact with victims and witnesses and are therefore in a position to diminish the immediate traumatic stress. In this particular case where the victims are children who’ve lost their parent, the response is more critical because children grieve in a unique way. Their grief cannot be predicted and can be very present in their actions which can last for years, sometimes throughout their childhood and pieces into adulthood.

Therefore, it is important to communicate. So the first bit of intervention is to identify the proposed adult that is present and in the place of authority and with their permission and assistance, identify the children and introduce myself to them as someone that is there to assist them to get through this very difficult time. There are seven steps that must be implemented during this grieving process according to (Wright, 2012, p.368). They need to accept and express the loss and while experiencing the pain. They would require assistance identifying the wide range of emotions they’re experiencing. They need to understand why they and others around them are sad and that it is ok to be sad but more importantly this is how you feel when someone dies. Children need to be encouraged to not only remember but review their relationship with their loved one, learn to relinquish and say goodbye to what’s lost. With older children, you might want to incorporate prayers. Don’t be intrusive, seek their permission, perhaps by asking “”How can I pray for you at this time? By following this guideline, not only are we teaching children that loss is a natural and inevitable part of life but if done effectively, we are assisting in equipping them to handle the losses of their adult lives better.

Conclusion

Life is difficult without doing anything and by accident of birth, the quality of your life is determined to a great extent without your participation or contribution. Crisis and possibly trauma is a part of everyone’s journey at some point before you depart from this world and the way you progress through those difficult periods is dependent heavily on the immediate and possibly ongoing guidance of some first responder. With children, the adult has to be the carrier for the most part and basically monitor closely for signs of post-traumatic stress disorder of any kind. The Bible admonishes us in (Proverbs 12:25 New International Version). to “”Cast all of our anxiety on him because he cares for us. (Philippians 4:6-7, NIV) “” Do not be anxious about anything, but in everything by prayer and supplication with thanksgiving let your request be made known to God. At the end of the day and when all else fails, if you’re a Christian, we have hope in a Savior that cares for us.

References

Rates of post-traumatic stress disorder in trauma-exposed children and adolescents: meta-analysis by Alisic, Eva; Zalta, Alyson K; van Wesel, Floryt; More… The British journal of psychiatry: the journal of mental science, 2014, Volume 204, Issue 5 Briggs-Gowan MJ, Carter AS, Clark R, Augustyn M, McCarthy KJ, Ford JD.

Exposure to potentially traumatic events in early childhood: differential links to emergent psychopathology. Journal Of Child Psychology And Psychiatry, And Allied Disciplines. 2010;51(10):1132-1140. doi:10.1111/j.1469-7610.2010.02256.x. Briggs-Gowan MJ; Carter AS; Clark R; Augustyn M; McCarthy KJ; Ford JD, Journal Of Child Psychology And Psychiatry, And Allied Disciplines [J Child Psychol Psychiatry], ISSN: 1469-7610, 2010 Oct; Vol. 51 (10), pp. 1132-40; Publisher: Blackwell Publishers; PMID: 2084 0502; Corr, C. A. (1999).

Understanding and helping children and adolescents when a parent dies. Death Studies, 23(1), 89-95. Retrieved from http://ezproxy.liberty.edu/login?url=https://search-proquest-com.ezproxy.liberty.edu/docview/231350060?accountid=12085 Heuristic. (n.d.). In Merriam Webster online dictionary (11th ed,).

Retrieved from http://www.m-w/dictionary/heuristic. Kanel, K. (2018). A guide to crisis intervention ( 6th ed.). Belmont, CA: Cengage Learning. ISBN: 9781337566414 Wright, H.N. (2012). The complete guide to crisis & trauma counseling: What to do and say when it matters! (Revised ed.). Bloomington, MN: Bethany House Publishers. ISBN: 9780764216343 http://www.sciencedailey.com/releases/2008/05 http://www.nasponline.org

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