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The impact of environment together with the personal features are crucial components that predetermine human behavior. Hence, responses to the negative life events represent complicated factors that usually vary among individuals depending on age, gender, personality, previous experiences and even the accompanying circumstances. However, if the detailed analysis shows that the experiences of people differ, there are some aspects that can be generalized and considered a common background that might lead to short-term or long-term psychological trauma. If a person defines psychological trauma as a reaction to some negative experiences including the disease, loss of family member, war, violence and others, there are good reasons to analyze what assistance the patients will need and what factors will lead to faster recovery or vice versa problem aggravation. Therefore, it is necessary to seek for the objective laws concerning the impact of negative experiences on human brain from the sociological, psychological and spiritual perspectives to offer the most effective support to patients and their relatives in various traumatic situations. The aim of the current paper is to analyze traumas and PTSD in particular as a psychological injury caused by some negative event that is usually associated with misperception or denial of the reality and should be treated as a complex problem that encompasses cultural, societal and individual features.
The word trauma is widely used not only in medicine, but in everyday life of a person. Its definition is mostly associated with some injury caused to a person. According to Zhang (2014), the word “trauma” derives from Greek and means “damage caused by external forces” (p.117). Another opinion on this phenomenon was offered by a French psychiatrist who put emphasis on the connection of trauma with hysteria (Zhang, 2014). In general, it can be regarded as an emotional response of the individual to the experiences that are disruptive for him/her for some reasons. However, the traumatic experiences can rarely be analyzed separately from the environment a person lives in. Zhang (2014) has even offered a differentiation between the collective and personal trauma to emphasize the significance of the society in the formation of human identity. Trauma can also be defined as a direct personal experience that involves actual or threatened death or serious injury (Briere & Scott, 2014). In addition, it can be witnessing of death or injury-related event as well as learning about some act of violence. Fear, helplessness and horror are the feelings that accompany such events (Briere & Scott, 2014).
According to the statistics, 60.7% of males and 51.2% of females experience at least one potentially traumatic event throughout their lives (Javidie & Yadollahie, 2012). Death has a strong impact on any person and can be regarded as a good example of the traumatic event. However, in many cases it is associated with fear due to lack of understanding of its nature. Being perceived as loss or end of the world, death of a close person can lead to serious negative consequences for the mental state of the griever. There exist many theories related to healthy grieving as a reaction to pain that would not lead to serious emotional trauma. The most well-known theory related to the death experiences belongs to Kubler-Ross’ and offers several stages of grieving that are usually similar for all people. These stages include denial, anger, bargaining, depression and acceptance (Kubler-Ross, Kessler, & Shriver, 2014). Each of five stages describes important aspects of natural reaction to loss. Denial is characterized by perceiving the world as “meaningless and overwhelming” (Kubler-Ross et al., 2014, p. 10). Anger is a stage of healing that usually leads to the question of “Where is God in this?”(Kubler-Ross et al., 2014, p.13). This stage indicates that a person finds the events unfair and indicates the level of love towards the person who died. Bargaining is an attempt to bring someone back by means of various promises to God. However, such bargains can become effective, and a person has to understand it. Depression is another essential step that proceeds with the final stage of acceptance, which means recognizing a new “permanent reality” (Kubler-Ross et al., 2014, p.31). Mainly recognition and acceptance of the events that cannot be changed lead to the healing of a patient.
What is important about such model is that acceptance is the final and essential stage. Even though the previous phases are irreplaceable to ensure the psychological health of a person, mainly the deep realization and acceptance of the events regardless of how negative they are can finally lead to emotional stability. Regardless of how different the reactions of people may be, acceptance is the main sign of the mental healing and psychological balance. In brief, sufferings from death can cause temporary shock, further anger that can be directed at someone or something, ineffective attempts to change the situation, which is in fact not in human competence, depression and finally acceptance of the situation (Kubler-Ross et al., 2014). Nevertheless, it is not obligatory to go through all of the above-mentioned phases in a definite sequence. Cultural beliefs, psychological health and different circumstances lead to differences in the human perception of the negative experience and survival though grief.
In any way, social and cultural context of trauma is crucial not only for its strength, but also for the recovery. It is widely known that a person can rarely overcome serious mental problems independently. Hence, the reaction of the society predetermines the treatment. As for the cultural aspect, it predetermines both the reaction of the society and the reaction of the person as well. For instance, humiliation can be a serious undesirable accompanying feature of racism or sexual minorities related traumas (Zhang, 2014). At the same time, family background, upbringing and socioeconomic status are crucial for the understanding of the situation.
The emotional traumas or PTSD can be predetermined by different traumatic events. Throughout the history, people have seen the social influence on the emotional state of the citizens. For instance, Albert Camus defined the 20th century as “the century of fear” to show that it was filled with traumatic events that include wars, technological disasters, violent personal assault such as sexual violence or physical attack, kidnapping, terrorist attacks, car accidents, natural disasters, the death of the close people or a number of other shocking events (Javidie & Yadollahie, 2012). As for the childhood age, the most shocking events were defined as follows: sexual abuse, witnessing serious injuries or unexpected death of a close person (Javidie & Yadollahie, 2012).
Mathias et al. (2014) referred to the sports injuries and related assaults in order to analyze how mixed injuries can be interrelated with the further psychological traumas. The point is that a deeper analysis of the patients’ history shows that traumatic injuries of the brain are commonly the result of the car accidents, or some physical assault (Mathias et al., 2014). Mainly for this reason, physical injuries are strongly interconnected with the psychological ones. In this regard, there exists a strong interconnection between the cause of the trauma and the further treatment and other outcomes. Moreover, in regard to litigations that can accompany the traumatic brain injuries, one can also see that the emotional trauma demands immediate intervention in order to avoid further possible complications related to the inappropriate court decisions or possible conflicts with the opponent. Finally, any physical trauma has an impact on the brain functioning. Hence, the consequences of the negative events can definitely get aggravated.
Some researches show that the reasons for the emotional trauma or PTSD can vary depending on the gender and age of the patient. For children, natural disasters and abuse are the most common reasons of traumas. Sexual assault is the most widely spread reason among women and war is an intense stressor for men. Javidie and Yadollahie (2012) report that armed forces are marked with a high level of depression, anxiety disorders, alcohol abuse and PTSD. Consequently, one can see that emotional traumas can be predetermined by the personal life, choice of profession and personal features. Brier (2014) offered the following division of traumas according to various characteristics: emptiness, loss of spirituality, self-blame, depressive disorder, complicated grief, psychosis, anxiety disorder, stress, PTSD, acute stress disorder, adjustment disorder, dissociation, somatoform responses, brief reactive psychosis and others. Among these conditions, PTSD can be regarded as a particularly complicated type of stress accompanied with persistent disturbing symptoms (Brier, 2014).
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Post-traumatic stress disorder is regarded as a strong emotional trauma caused by a sudden traumatic stressor (Javidie & Yadollahie, 2012). However, such stressor can lead to a long-term or short-term stress. Hence, the PTSD can be divided into two types: the chronic and the acute one (Javidie & Yadollahie, 2012). The disorder is regarded as chronic if the symptoms last longer than three month. Otherwise, the disorder is regarded as acute and is estimated as less harmful for the emotional health. PTSD is characterized by various changes in human state. These changes take place in several domains. Among such, one has to deal with the reminders of the event that can lead to flashbacks, various intrusive thoughts or nightmares. Another domain is activation that includes “hyperarousal, insomnia, agitation, irritability, impulsivity and anger”. Finally, the list of domains includes deactivation characterized by avoidance, numbing, confusion, dissociation, and depression (Sherin & Nemeroff, 2011). Consequently, such reactions lead to a number of limitations and minimal functional impairment throughout different time periods (Sherin & Nemeroff, 2011).In addition, such long-term complicated stress can also be accompanied with such medical conditions as back pain, hypertension, arthritis, nervous system diseases, digestive or endocrine disorders, strokes or even cancer (Brier, 2014). Hence, it is important to keep in mind the close interconnection between the physical and emotional health.
In most cases, war is an event associated with a number of traumatic experiences being a common reason for the development of PTSD (Nash & Litz, 2013). In this case, the patient has to deal with the multiple moral injuries on the personal, family and community levels (Nash & Litz, 2013). The statistics shows that the cultural or country belonging, gender and age are the factors that can predetermine the prevalence of PTSD. Younger people are more predisposed to PTSD than older ones. The gender index shows that PTSD prevalence is significantly higher among women (Javidie & Yadollahie, 2012). As for the comparative analysis between countries, the PTSD prevalence is higher in China than in New Zealand. The risk factors that predetermine such difference include the rate of crimes, accidents and various disasters on the territory of the country. Among the most common patients suffering from PTSD, one can find the victims of rape and disasters, as well as the rescue workers including policemen, firemen, and emergency service workers (Javidie & Yadollahie, 2012). As for the symptoms that accompany PSTD, one can witness chronic dysfunction, delayed reactions and psychological resilience (Bonanno & Mancini, 2012). However, the same authors emphasize the crucial importance of individual differences for trauma development and treatment.
The above-mentioned consequences of trauma and PTSD in particular lead to the creation of a reflexive nervous phenomenon that shapes the further survival behaviors aimed at coping with stress. Some circumstances can become uncontrollable in the process and cause functional impairment among those who suffer from post-traumatic stress disorder (Sherin & Nemeroff, 2011). Such disorder is followed by some neurobiological abnormalities and often leads to biological vulnerability. Several pathological features common for PTSD are similar to those that follow traumatic brain injuries (Sherin & Nemeroff, 2011).
The effects of trauma can remain negligible if the professionals and people around do not provide a person with sufficient help and support. However, in regard to the influence of both inner and exterior factors, one should understand that it is not always easy to cope with certain traumatic issues. Based on the Freudanism, some psychologists suggest that traumatic experience can change “the nature of individual’s memory, self-recognition, and relational system” (Zhang, 2014, p. 117). In addition, traumas can alter the psychological, biological and social equilibrium and lead to irreversible changes in human behavior and perception due to the neglect of all experiences except one. The influence of traumas on the memory of people can result in the division of consciousness and lead to helplessness and “emotional paralysis” (Zhang, 2014, p. 117). In addition, the trauma related memories can become repetitive and lead to various nightmares or associated effects. Hence, the pain that is caused by the trauma demands serious and attentive treatment that would help the person investigate his/her personal awareness of the past situation.
A number of different symptoms that influence the life and overall level of citizens’ happiness usually accompany PTSD. 84 % of people with PTSD point out the following comorbid conditions that even worsen their state: alcohol or drug abuse, shame, despair, consequent problems with employment and personal life (Javidie & Yadollahie, 2012). In addition, PTSD is usually accompanied with some disorders. Among such, one can observe anxiety disorders, such as panic and social phobia, major depressive disorder, substance or alcohol abuse, conduct disorder and even different types of mania (Javidie & Yadollahie, 2012).
Dealing with the injuries related traumas, one can also find some common psychosocial and emotional (postconcussion symptoms, injury-related stress, and depression), cognitive (memory, abstract reasoning, problem solving, and verbal fluency), and functional (general outcome; resumption of home, social and work roles) outcomes that should all be assessed. It is quite interesting that even the trauma that took place long ago can reveal in the person’s memories and have a considerable influence on the entire life of a person. Sometimes, traumas can lead to revictimization throughout life. In other cases, addictive impact of traumas can be observed (Brier, 2014). In any case, the factors that influence trauma development and treatment are victim variables, gender and race, trauma characteristics and social factors (Brier, 2014).
Faith is a very effective supportive means of coping with the sufferings and traumatic events. Different religions have different views on sufferings of people and overcoming death of a close person in particular. These beliefs shape various spiritual moods among people. Because death is an inseparable part of human life, it has to be accepted as it is. Hence, the motive of acceptance appears in religion similarly to what can be found in the works on psychology. However, a number of examples can be used to prove that faith is very effective in buffering the negative emotions as well as psychological and physiological health outcomes (Walker & Aten, 2012). In this regard, it is essential to understand not how religion determines the outcomes, but how a person can utilize and apply religious concepts. Seirmarco et al. (2012) has emphasized that self-perceived changes prove the importance of religious beliefs when dealing with traumatic events. In many cases, the disasters and various attacks lead to the raise of religiosity among people. 11% of people report changes of beliefs in direction of spirituality after traumas and 9/11 attacks in particular (Seirmarco et al., 2012). Interestingly, Krause and Hayward’s research has provided both supportive and denying evidences to this assumption. Their study shows that traumas can lead to both raised doubts as well as stronger devotion to religion (Krause & Hayward, 2012). Drumm et al. (2013) have emphasized that spiritual-based survival and resilience practices are quite helpful for the Christian women who suffer from abuse. In such a way, spirituality can be defined as an effective way of self-healing (Drumm et al., 2013). Neimeyer and Burke (2015) have also emphasized that the spiritual construct of grief is the model that effectively leads to the perception and acceptance of the problematic reality. Hence, this aspect can be used effectively in psychological practices when dealing with trauma treatment.
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Due to the fact that the loss of a close person is a distressful emotional experience, it is not always that easy to accept it. However, the religious views on this issue show that the balance in the world is crucial together with the acceptance of the God’s laws. Some sufferings and exterior influences are among the ways to perfection. However, the traumatic experiences are not always associated with death and not always happen to an adult person. Walker and Aten (2012) have focused on child abuse and the approaches of the Christian church regarding this issue. The psychological training and Christian counseling are the most common means of solving the problem. Christian training programs consider two aspects when dealing with such traumas. Firstly, secular best practices for evidence based treatment should be used. Secondly, the effective treatment should include TF-CBT (Walker & Aten, 2012).
Intimate partner violence is also treated in a particular way by the church. The basis for the Christian counseling in regard to this issue is the Biblical writings from Ephasians that teach “to love one’s wife as Christ loves the church” and “to love one’s wife as one loves their own body” (Walker & Aten, 2012). The treatment of women experiencing domestic violence should be based on Cognitive Processing Therapy.
The respond to the survivors of disasters is a bit different. Firstly, it is necessary to understand that disasters can be accepted by the religious people in two different ways. Firstly, one might believe that it was God’s punishment for the wrongdoings. The second option is to believe that the God was helping all the time. Hence, clergy who put much effort to provide help to people who have suffered from hurricane Katrina or other disasters should provide the most effective understanding of the events that would let people overcome their negative emotions and ensure quick recovery (Walker & Aten, 2012). Psychological First Aid is the primary means of treating such traumas (Walker & Aten, 2012).
In general, competent addressing of spiritual and religious issues is crucial when dealing with the above-mentioned traumatic events. It is obvious that Christian teachings and scripts are the basis for the spiritual approach. The book of Jobs deserves particular attention due to its deep ideas on sufferings perception that are offered to the Christians (Walker & Aten, 2012).The shared experiences of the community are used to provide the effective lessons on spirituality to the citizens, who were abused or were involved in some wrongdoings. The healing practices of the religious foundations are also effective due to the involvement of the trauma advisory board as the one that shows the possible unification of the psychologists and spiritual leaders on the way of providing the most effective treatment (Walker & Aten, 2012). In addition, accommodating trauma therapies is an efficient treatment for the victims of abuse of different nature as far as it is based on the following crucial aspects: church-based interventions, peer support, lay counseling and prevention (Walker & Aten, 2012).
The use of the special psychological training at the church proves that spirituality and religion have to be tightly interconnected in the process of the emotional trauma treatment. Bryant-Davis et al. (2012) have emphasized that the recent years have been marked by the emergence of studies on post-traumatic treatment that take into account the religious and spiritual aspects. Hence, one can conclude that the competent care has to comprise all aspects of healing. What is even more important, Bryant-Davis et al. (2012) prove that it is necessary to use the spiritual practices not only for the adults, but also for the treatment of children’s traumas.
Trauma treatment always demands the attentive prior assessment of all possible variables and circumstances. The immediate concerns about trauma usually include the life-threatening circumstances and the level of their impact on the psychological stability and stress (Brier, 2014). The nature of trauma and validation of the responses are further steps on the way to defining the most effective treatment. As for the preparedness of the health care professional and people around, it is necessary to point out the following demands. It is crucial to provide a patient with respectful and optimistic attitude, safety, regulated environment and sensitivity to the cultural issues (Brier, 2014). Psychoeducation is an important component in trauma treatment that helps effectively deal with the underlying reasons. Such education can be quite helpful in making choice about the most effective approach. However, in the majority of cases, it is necessary to transfer the traumatic experiences into a cognitive state instead of the emotional one. Grounding, relaxation, counting, working with thoughts and construction of adaptive strategies can be some of the effective techniques (Brier, 2014). Problem identification, relational disturbance and biological aspects should become part of treatment. The common professional approaches to trauma treatment include cognitive processing, emotional processing, trauma processing, hot spot processing and others (Brier, 2014).
In addition to the above-mentioned approaches, Wilson, Friedman, and Lindy (2012) emphasized that ego state of the client is crucial for the appropriate choice of treatment. Hence, the scholars have focused on such aspects as trauma impact on the identity and personhood, allostatic disruption of life and modification of stress response mechanisms, restoration of personal dignity, worth and continuity (Wilson et al., 2012). Hence, regardless of what approach has been chosen, treatment of traumas is always associated with the choice of the most effective means of normalizing stress response, reducing the negative psychobiological processes and carrying out the cognitive-behavioral therapy.
One should put much effort not to let the consequences of the emotional traumas negatively affect the psychological health and further life. It is essential for a person and surrounding people to understand whether the professional help is needed and provide a person with support and safe environment. The psychologists and representatives of the Church are the sources of counseling for those who have to deal with the death of close people or terminal illnesses that lead to the short-term emotional traumas or deep PTSD. Although they offer different approaches to treatment, the common feature is the representation of grief as a life lesson that brings something useful. Even though sorrow, numbness, guilt and anger are all normal reactions to loss, it is important not to get obsessed with grief, but accept it and live further hoping for the best. Acceptance is based on the cognitive processes in human minds and should be based on the understanding of the reality without the accompanying emotions. Finally, both the spiritual and professional psychological treatment is helpful for overcoming stress and coping with the possible negative consequences of trauma. However, PTSD is a deeper problem that demands deeper analysis of all variables and consequences in order to make professional support as effective as possible.
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