Understanding Repeated Trauma: Heal structures, not just the symptoms

The difficulties of attaining a durable peace in contexts of protracted violence suggest we know more about how to end something painful and damaging to everyone but less about how to build something desired.
— John Lederach. The Moral Imagination: The Art and soul of building peace.

Last night I found myself in conversation again discussing the difference between long term trauma and short term trauma. And each time that I have this discussion it seems more and more clear to me that our treatment models focus mainly on symptoms. Loud symptoms as I call them. They focus on symptoms because they must: flashbacks, panic attacks, insomnia, rage and violence, depression, substance abuse, suicidality—these can be some of the very serious symptoms of repeated trauma. And they must be soothed, quieted, stabilized.

But it is a very rare occasion when the treatment should end there. Repeated trauma is really 3 kinds of trauma: the trauma that did happen, the protections you created to survive the trauma, and what didn’t happen—the developmental growth you missed while the trauma was occurring. The symptoms typically go with what did happen. But once the loud symptoms quiet down, once the flashbacks and the panic attacks stop, there are the invisible walls. These walls were protection, and everyone’s walls can look slightly different. Some just have walls. Others have moats and walls. Some people have turrets and armed guards.

The research on healing long term trauma shows that you can quiet the loud symptoms with treatment, but quieting these symptoms doesn’t by itself, improve the other aspects of a survivor’s life: their relationships, their work—where they can still be having significant problems.

Quieting the loud symptoms is a must. It is the ‘peace accord’ of a possible healthy relationship within the self. But it is only the beginning. It is not the treatment. It is the prequel to the treatment. Loud symptoms mean the war is still raging in some form. Loud symptoms mean that you can’t actually heal the trauma yet because it is not safe to do so. A peace accord isn’t nation building. It isn’t repair. It isn’t redevelopment.

A peace accord means that all of those things lay ahead as a possibility. A peace accord means you have the space to survey the damage and bring in new supplies.You can begin to assess the structures: both the protections you created and the parts of your self that need shoring up—that didn’t get to grow properly.

And I want to add strongly that you will find more than walls and damage: there is a power in trauma. Trauma requires a strength and a resilience to survive. Healing from trauma allows you to see these strengths---in addition to seeing what was shattered. But the work of healing is a work of revealing: what got hurt, what you built to protect yourself, what didn’t get built and needs to in order to function well.

It is so important for survivors and the loved ones of survivors to recognize that treating the symptoms is crucial for treatment, but it isn’t what heals the trauma. It is what allows the healing to begin. Heal the symptoms so you can begin the mend the structures—the structures that allow you to be whole and connected in your relationships, the structures that allow you to feel and express emotion in a healthy and safe way, the structures that allow you to connect to your strength and resilience and put them into action to live the life you want. These structures that your children will just see as a parent who cares, as your spouse will see as a real partner, as your co-workers will see as a someone they can trust and depend on.

But most of all, these structures will be something you can feel. They are the ground beneath your feet that doesn’t move. They are the deep breaths you can take and manage most things. They are trust that you have in people, in relationships and in a new future. You will feel the steadiness of having done the hard work of healing: you will not be thrown by the past, you will instead rest on it, knowing you have come through it.

© Gretchen L. Schmelzer, PhD 2015