SAIF Golden Charter

Dr Bill: Crisis of surviving

Once again, the world has been shocked by an act of terror which has claimed many lives and injured scores of others. But that it has occurred not in some remote or far-off location but right here at home in Manchester, and at a concert attended by families and children, brings home to us again that the world we live in can be a dangerous place.

This age of social media has meant the average citizen is exposed to many national and personal tragedies, shootings and bombings on our TVs, computers and phones. It seems unbelievable when it happens.

But how much more unbelievable it must be to those directly involved. One comment repeated in almost every situation is: “We didn’t think something like this could happen here.” While we are painfully aware that tragedies occur, we insulate ourselves by assuming that they happen to “other people”, “somewhere else”.

So when tragedy does strike, there is often a sense of disbelief. Many assumptions we held about our life and world can be instantly violated and shattered, causing surprisingly intense insecurity and anxiety.

It is important to remember “a crisis is not an event; a crisis is a reaction to any event”. This bombing is a traumatic and tragic event. The individual or community’s reaction to the situation constitutes the crisis. A crisis occurs when coping mechanisms are overwhelmed. This explains why in the same situation some people seem to cope well and handle things, while others appear to fall apart.

Survivors’ challenge is to make meaning of their present symptoms in light of past events. For those caught up in the tragedy, it is about the speaking the unspeakable.

Some situations seem too terrible to even utter aloud. We find ourselves unable to process the reality of what has happened or put it into words. But atrocities refuse to be buried. Almost as powerful as the desire to banish them from our thinking is the realisation that denial does not work for long.

Appropriate grieving allows people and communities to recover, to heal, to learn and to grow. Four things will be important for those affected by the Manchester tragedy in the coming weeks and months.

1. Re-establishing safety

Trauma robs its victims of a sense of power and control. Realising we were unable to control and are now unable to undo what has happened, or recover what has been lost, often undermines one’s sense of competence. Any intervention must begin by reassuring the individual they will be okay. In an instant their world has become unsafe; this needs to be understood and addressed first.

2. Reconstructing trauma

The second stage is more cognitive, by which I mean capable of knowledge. With a sense of safety established, the person feels able to begin telling their story.

Tragic events cannot be avoided, as much as we might like to think they can, and there are no quick solutions. People need information about a tragic event: What happened? What does it mean for me? How does it affect me? What can I do?

This provides the opportunity to offer education on what the person can expect, and the effects of trauma and grief. This will legitimise what they are going through and lets them know their emotions and reactions, while complex and difficult, are natural.

3. Feeling the feelings

Telling the story in words inevitably involves profound grief. Frequently people resist mourning not only out of fear but pride. We want people to think we can “handle it”.

People progress best when their feelings are legitimised and validated. Others’ attitudes, reactions and support are powerful influences on their journey. Retelling the story makes it part of the survivor’s experience, but only one part.

They may even realise it does not have to define, far less destroy them. However, a word of caution – this counselling must be done with care by those who understand the dangers and triggers of trauma.

4. Empowerment by taking control

The major goal in treating post-traumatic responses is empowering survivors.

Gaining some sense of control can mitigate feelings of helplessness. Thousands of lives were changed forever by the events in Manchester. Coping with victimisation involves rebuilding the shattered assumptive world, and incorporating into one’s own identity the experience that these things happen – even in Manchester.

As Winston Churchill said in another of England’s darkest hours: “We shall draw from the heart of suffering itself the means of inspiration and survival. We shall never give up… never, never, never!”