Original article posted by Dr. Clarissa Pinkola Estés on Facebook, Tuesday, February 22, 2011.
Indonesia. Katrina. Haiti. New Zealand. Japan. Myanmar. We can’t control the earth and what she does to realign herself. There is constant transition here, often matching what goes on in our social world (Iraq, Bahrain, Egypt, Libya, Yemen, Wisconsin…) and in our personal, individual lives. Change is the only constant. But big change can bring traumatic reaction we often hold in our bodies, minds, and memories.
On her Facebook page, Dr. Clarissa Pinkola Estés, a psychoanalyst (best known for her book Women Who Run with the Wolves), posted an open letter to New Zealanders who experienced the large earthquake there this past February. In it she gives valuable tools and information for dealing with the aftermath of disaster, offering information on what normal reactions to loss are as well as steps to take for recovery.
Dear Brave Kiwi and All Other Souls:
This is for you. I’m a Psychoanalyst and Specialist in Critical Incident and Post Trauma Recovery, who developed psychological recovery protocol for the Armenian earthquake rescue, served at Columbine High School and community for three years after the massacre, and still work with 9-11 survivor families on both US coasts.
I’ve enclosed here for you, the complete protocol in letter form, that I developed and have used to train therapists and citizen-helpers so they can help themselves and help others with post-trauma recovery at disaster sites.
This letter is addressed to the inner circle of victims, survivors, eye-witnesses, their families, workers, helpers, rescuers, and other affected persons. This letter lists what I have found, now in my 41 years of clinical practice, to be useful, effective, and time-tested steps for recovery from trauma.
RECOVERY AND NORMAL REACTIONS TO SUDDEN SHOCK, EMERGENCY, LOSS, INJURY, AND CATASTROPHE
by Dr. Clarissa Pinkola Estés
Each person, depending on their innate physical and emotional constitution, their time of life, the day to day challenges of life, is affected differently by sudden shocks and catastrophic events. Symptoms that rise from shock may differ from person to person also.
Thus, over a period of time, if you of ‘the inner circle,’ that is, if you are an eye-witness, a helper, a first responder, a victim, a survivor, a person who lost a loved one, or had a loved one in the path of danger, or seriously injured… if you have been suddenly hit hard by tragedy… if you are military, fire fighter, worker, helping-professional, law enforcement, rescue worker, citizen rescuer, news gatherer, photographer, or connect to the tragedy in other close-in relationships, you may find yourself having one or more of the following reactions.
The following are normal reactions to sudden shock relating to life and death events, to sudden twists of fate. When one has been involved in a critical incident, the body, mind and heart, and some believe too, that the spirit and soul, are shocked as well.
This is because it is shocking to see in full consciousness, in a split second, how close death suddenly came into our world, how fast, and often at first, how quietly… This witness is arresting to any human being with a heart and soul.
The most time-tested remedies I know from my forty-one years of clinical work in post-trauma recovery are outlined right after this list of common and normal reactions:
o Sleep disturbances including inability to sleep
o Lethargy, such as sleeping too much
o Exhaustion, fatigue
o Changes in appetite, digestive disturbances
o Feeling numb
o Crying, sometimes without necessarily knowing why
o Desire to comfort and be comforted physically
o Nightmares, night terrors
o Loss of memory
o Trembling, inner or outer
o Heart arrhythmia
o Pain in heart, not an organic disorder, but caused by sorrow
o Aching bones, not an organic disorder but rather, caused by sorrow
o Headache, pre-migraine symptoms; migraine
o Poor concentration
o Refusing to talk
o Wanting to go away, or hide
o Talking ‘out of one’s mind’
o Startle reactions while awake or asleep
o Isolating, wanting to be alone.
o Wanting to just sit, or just stare
o Trying to help in any way one can, to the point of exhaustion;
o Not wanting to leave the scene
o Hyper-vigilance, watching, listening, being unable to be at rest
o Loss of sense of time
o Feeling distraught and helpless
o Feeling that things are not real, as though in a dream
o Inability to recall sequences or retrace all of one’s steps
o Feeling the future has been lost forever
o Desire to comfort and be comforted psychologically
o Feeling one should not cry
o Wanting to scream, or screaming-weeping
o Inability to attach importance to anything but this event
o Intrusive thoughts that cause anxiety
o Over-reactions to mild to moderate irritations
o Recurrent dreams
o Horrified Anger
o Broken Heart
o Insecurity about the future
o Feelings of fear
o Feelings of guilt
o Feeling one cannot stop crying
o Unusual reserve, acting as though nothing much really occurred
o Blaming others, individuals, groups: there may be passionate outbursts
o Marked frustration with how long everything takes
o Marked frustration with rescue workers, the bureaucracy, anyone who tries to help
o Marked frustration with any who break promises to help, or who are perceived to not be telling all the truth, or who are perceived to be withholding critical information, or giving misinformation not telling all they know, or who are giving out platitudes or being condescending
o Ongoing violent fantasies
o Rolling episodes of anxiety
o Mild to profound depression
o Thinking no one can ever understand, no one can ever help.
o Keeping secrets about what one might have known beforehand
o Blaming oneself.
o Deep dread about hearing any more terrible news.
o Aversion to films, movies, radio, television, anything that depicts catastrophe.
o Desire to comfort and be comforted spiritually
o Questioning God, being angry with God
o Not wanting to hear any spiritual counsel
o Wanting very much to hear spiritual counsel
o Feeling God has abandoned everyone
o Feeling God is ever near
o Praying non-stop, for self, for others, for everyone
These are normal reactions, and they can be painful. Thankfully, no one has all of them, and some, such as more prayer than usual can be helpful to many. Going through these shock symptoms, trying to pinpoint each or some, and finding one’s own ways of easing these, putting first things first… this is all part of the direct healing process.
No one can instantly cleanse these thoughts and feelings away, though I wish we could, for I know they can tear at heart, mind, soul and spirit and make people feel half-dead or in continual dread.
But as time passes, many of these will pass too. The most important is to know what to do for oneself to help the natural process of mending up after twists of fate that affect us so deeply. Some years ago we lost our first born grandson and made the slow painful walk back from the land of the dead, one of the most succinct truths about coming back after such trauma, came from my dear daughter who said it so well: We never overcome profound loss: We learn to live with it.
And this will assuredly be so for you also. You will find your way to live fully again with this time in background, not foreground. And you will see, month by month, this will occur. For some persons, after tragedy, they know immediately what they think and feel. For others who are numbed, they may not know where and how they stand with the events and with themselves for a time afterward.
That’s alright. It will come. Being thoughtful and watchful of one’s own processes is a good endeavor. If you can’t quite decide, ask trusted others to help you take steps to help yourself as, and if, needed.
For those close in to the disaster, the tragedy, the numbness you feel is your psyche protecting you, softening for a time, the profound overwhelm of all that has occurred, allowing you to at least go through many of the mundane motions of the day to day.
For the first days after such enormous shocks, it may almost feel as though time has stopped. That all is surreal. You may feel as though you are no longer here. As though maybe you are dead or deadened. This is because abject fear, horror, and/or tragedy throw us into a process and locks us in for a time.
For most who have been suddenly beset by deep fear, and/ or suddenly lost a beloved person, or a furry relative, or a homeplace… ‘descent’ is not too strong a word for the process after. To many, it feels like a big iron gate has closed behind them and that life will never be the same again.
And yet, also be assured that there is an indirect healing process that is taking place underground at the same time… time passing is one indirect healing partner. As time goes on, there is also blessing news… and that is, that fear and horror and grief are processes that have a beginning, a middle and not exactly an end, but a release from that trapped place where you may have felt burdened back and forth, relentlessly.
Eventually the sense of helplessness, fatigue, guardedness, hyper vigilance, sorrow, and ‘not knowing,’ dwindles and eases. You will daily live and laugh and love life again, more and more … it will happen. Not right this moment. But it will come.
As time goes on, less and less will you be dragged backward in time to very briefly, but deeply, feel fearful or grieve anew. Those times will occur with longer and longer spans of time in between. Each episode of ‘sudden remembering’ will be intense, but last for shorter and shorter periods of time. Again, for most of us, we do not ‘get over’ life and death heart-wrenching events. We learn to live with them.
We learn to live with the aftermath of memories of bad shocks and irretrievable losses. We learn to live with changes and losses that feel they took meaning of our lives away from us for a time, or that took our souls from us and our desire to live life as well.
But the innate Life Force is ever sending out strong impulses for us to live again… and well. The Life Force is muscular, no matter how weak we feel in the moment. It will help us see meaning, and new calling in life sometimes too, as we gradually climb back up to our own vital and vibrant lives in every way. It will come.
Please take up all, or any of the following ways to help yourself and know too, that many many strangers, as well as those close to you, are focusing in this very moment on supporting you over the miles, saying strong and ongoing fresh prayers for your hearts and souls to find their ways and to be made whole again.
ACTIONS TO TAKE FOR RECOVERY
— Within the first days or as soon as one can, do strenuous exercise alternating with relaxation. Continue to move daily thereafter. This will alleviate some of the physical reactions, and give your body a way to discharge additional physical and emotional reactions as they accumulate in the coming days.
— Keep busy, do not sit and do nothing. Feeling displaced, angry, sad, orphaned, and bewildered are normal reactions. Do not tell yourself that you have lost your mind. You haven’t. But it is as though a huge wind has blown through upsetting all previous order. Order will return. A new order. An order for your life that you decide as you decide it, in your own best interests.
— Talk to people — talk is one of the most healing things you can do. Tell your story as you see it. Although some have learned to keep their most precious thoughts and feelings to themselves, they may not realize that by talking some, or a good deal now, they also give others permission to talk out their thoughts and feelings too… and thus to go that much farther in healing. To talk, encourages others to talk. Though each has their own ways of dealing with trauma, and no one ought be forced to speak until or unless they wish to, we find that expression of one’s thoughts and feelings about trauma often go farther to release its after-effects, than trying to tough it out.
— This may be the first time some persons will receive encouragement to speak. Some will be brief, that’s alright. It doesn’t matter whether one’s talk is broken or cohesive… telling one’s own story insofar as one wishes, is what matters. People who have been deeply hurt, may tell their stories over and over again, many times before they lose their massive charge of pain. They may tell it in voice, or in drawing, painting, journaling, and other expressive means and then share this with trusted others.
— Don’t push yourself, but if you can, listen to others’ stories; if you can, reach out for those who are poor in resource, poor in spirit, poor in security, for sometimes giving comfort, words of encouragement, is a way to help healing of both teller and listener as well. There are many ways to listen, including being silent together, including a hand on an arm, an arm around a shoulder, an embrace while the other person just leans in quietly, or weeps.
— There are too, those inimitable words that the soul understands perfectly, which are not said with voice, but with nods of the head and with the eyes; gentle understanding eyes.
— Don’t allow anyone to push you or others by insisting, “It’s over now, we have to move on.” In grief and great change, the psyche has entered a sacred place, one of deep learning and transformative process. The news media cycle is not your healing cycle. In fact, protect yourself in the early days from any media who may accidentally overwhelm your spiritual needs for privacy in groups and as individuals, with media’s need to ‘feed the maw of the news cycle.’
–Neither is your drummer anyone who is not very well developed psychologically or spiritually themselves, nor those who become understandably fatigued with the, for now, ongoing cycle of anxiety and/or grief. Rely instead on compassionate and patient counsel.
— Also, listen to yourself and to wise others who have come through ‘a great something’ themselves, and mostly recovered. It is a paradox and an issue of compassion for self and others: To tend to what is wounded til healed ‘well-enough’, while going on with new life as well. Yes, ‘life goes on,’ as some will say, but the emphasis should be on Life! not on hurrying. A wound to the spirit and psyche is like a wound to the body. It takes time to heal from the bottom layers upward.
— Feelings of loneliness and deep feelings of worry, or longing toward loved ones injured, or now gone, can be partially mediated by being with those who understand from the ground up, that is, other people who have walked the path similar to the one you are walking now. Though it can seem like this never happened to anyone else and you are alone, there are others in the world, on the internet, at certain groups who know exactly what you are experiencing, and they can be of great comfort. Seek them and take what they offer in all goodness. It is there for you.
— Each time you tell your story partly, or fully, each time you create a symbolic act, a ritual, each of the best of what once was, memorialized now, each thoughtful new barrier set to help prevent ever again what twist of fate or tragedy occurred in your world insofar as you can, each time you think back to the disaster in order to analyze and learn something valuable, each time you receive someone’s caring, each time you reach to comfort others, to bless and be blessed by others, you will be healing yourself. And others.
— Try not to cover up your feelings by withdrawing or by using alcohol or drugs. Talk your feelings out. As many times as you need to. There is no shame or selfishness in this. You have been through alot. Sometimes after a sudden shock or tragedy, some are inclined to try to self-medicate with whatever is close at hand. But this is not a time of negating. The psyche is stronger than most realize. This time, despite the horror that began it, will be a time that will bring much to you, much that will be useful for the rest of your life. For many, it will be a time of complete maturing in unforeseen and good ways. We cannot make tragic or profane events go away, but we can make our actions regarding them, holy.
— Reach out to others for help. They really do care. Be good to yourself and let others be good to you too. Often, the most healing comes from just allowing others to bless your life anew, and you theirs. I tell the people I meet with who have suffered great tragedies, but who often ask what they can do to help others. I tell them, ‘be kind.’ People who suffer greatly will most often forget all the words that anyone ever said during these first days, but what will remain forever engraved in memory, are the kindnesses others offered during those first few days and weeks. Kindness somehow seems recorded by the body, by the mind, the heart, the soul and the spirit. Sense memory; every part of the person registers kindness.
— Spend time with others. There may be times of reflection and solitude. But, do not isolate yourself. You may also find yourself laughing sometimes, even as you grieve. That is not blasphemy: it is the Life Force trying to surface again. It is alright.
— Ask other people how they are doing. Remember they may be shy to tell a stranger, or even a friend or relative, of their burden unless they are asked, and often, they may need to be asked more than once in order to gain more of an answer from them than just ‘Fine,’ when in fact, they are somewhat– to a lot– less than fine.
— People can become fatigued from this business of remembering and grieving. Grieving is hard work and as numbness wears off and the psyche delivers back images and impressions of the original traumatic event, it can burn up much energy. Rest, take good care of your body. Feed it decent food. Soothe and energize your body.
— It’s alright to take time out. It is not negligent to not want to listen anymore. It is alright not to read newspapers or watch the news. It’s alright to never again go to a film that is about shock or loss, in order not to stir up what is now healing or healed. It is fine to protect the wound, even when ‘well enough’ healed, for now, for a while, and forever. Everyone reaches capacity in the grieving process, in recovering from great shocks. Pay attention to what your body and mind, heart and soul need, and secure it for them.
— Healing from shock is not a straight line, it is a zig-zag line, sometimes two steps back and three steps forward. Stay with it. There is no one right way or perfect way. There is your way. Trust it. Others may offer ideas too. Consider them, take what you need and leave the rest.
— Take time to think things through carefully if you are approached by persons offering legal help. For persons who are badly injured or for survivors of a family member who died, or those who have lost much, legal support may be considered. But, also be aware that in some instances, involvement in years’ long legal pursuits can thieve freedom to live life again as you please, and instead have one’s highs and lows dictated by how the legal case is progressing each day. Consider carefully. If you need a lawyer, it is likely best to seek your own referrals from trusted friends rather than respond to lawyers who contact you.
— It is true that some of your friends and relatives may never understand what you, the on-scene person, experienced unless they were there too. Sometimes the ones we turn to for support, just can’t give us enough. That’s alright. That’s why there are often survivor groups formed. The people in ‘the inner circle’ understand one another innately.
— If you find at any time that you feel stuck in endless anger, or want to isolate yourself without cease, or have unabated high anxiety, or continue to be hyper-vigilant, have intrusive thoughts, flashbacks, thoughts of hurting yourself or others, nightmares or other sleep distresses, over-reactions to run of the mill events, begin to destroy your most cherished relationships… don’t put it off … seek professional help. It is often only one tiny thing that needs to be tightened or loosened in mind or heart; not a total tear-down and rebuild of the entire psyche.
— It is not a character flaw nor a failure of selfhood to seek psychological, physical or spiritual assistance. Please understand that severe, sudden shocks to the body and mind can throw off chemicological balances in the body. Sometimes the body needs medicine to help to recover the chemical equilibrium that influences sense of self, even mood, and sense of ease with the world. Talk therapy with a therapist trained in post-trauma recovery is useful to untangle thought processes that often become jammed by prior pressure to respond to too many sudden and strong stimuli all at once.
— Therapy is also a place to speak the thoughts you would prefer not to speak more publicly or to friends or family. It also is a place of learning to create new life as you now wish it to be, with insight and vision. Some choose EMDR, a eye-movement therapy that reduces the anxiety of trauma for many; some choose talk; some analyze dreams, looking for symbols which free them when understood, some also take medication, as well as practice meditation, sit satsung, keep journals, do yoga, go fishing more often, take up new skills that relax them or go back to those that once did… and many use expressive arts to come to terms. Use any and all, as you see fit.
— If you are a parent, help your children by listening, listening. Just because your young children, or your young adult children are silent, or just because they laugh or go out with friends or say everything is fine, does not mean they are without need of your special regard. The psyche often splits in two during eye-witness and/or sudden trauma. This is a healthy and temporary adaptation. One side goes on functionally, while the other side maybe, for a time, drowning in bewilderment, helplessness, a sense of the surreal, and sorrow. The two ways of seeing and thinking will come back together again more and more, and with a united vision eventually. Don’t be afraid to talk to your children adult to adult. Do not hesitate to gain psychological advice and therapy, both for yourself and your child if you think that is useful and/ or needed.
— Therapy at its best is educative, teaches about how the mind and behavior and spirit actually work together, or don’t, but can… with a few adjustments and conscious good will. Children look to and often follow the tone their parents take about such matters. If you made an error of under or over reacting, just back up, say so to your child, say you know how to do it better now. The children learn so quickly, they will most often back up and follow your new and better lead. Perfection in grieving and coming back to life is not the point. What counts the most is that you just do your loving best.
— In the ensuing days, find things to do that feel rewarding, meaningful or refreshing. These need not be big things, but events or endeavors to offer some small balances to the tragedy and overwhelm you have been through. It is alright to live fully, even though precious others have been suddenly injured, harmed, or died. In fact, it is exactly right to decide to live fully in honor of those who currently cannot or could not. There is to be no guilt for moments of happiness or celebrations. Moments of happiness are, again, the Life Force erupting in your service. And this is just right.
— When you feel bad, find a person to talk to, and to cry with, to tell of your anger and other helpless feelings. Don’t keep it inside. If you think you’re ‘bothering people,’ remember people who love you will wind up spending much energy being even more worried about you if you go mute. It’s alright to talk, even if it’s not ‘your thing.” There are times of life that have great consequence that are worthy of speaking about. This is one of those times. For your sake. For the sake of others.
— You are vulnerable in some new ways when you’re recovering from shock; take care to not over-indulge or self-medicate with substances, or other mind-numbing addictions, or trying to lose oneself in unprotected sex.
— If you have spiritual practices, your spiritual beliefs will definitely help you through. Cleave to them in full. For those who have been dispirited by some inhumane religious person long ago, do not hold yourself away from this kind of healing for your spirit now. Instead, consider seeking people of spirit who love the soul; there are many of them in the world, some in organized religions and some who wander freelance in this wide world. Ally with them. They will have special balm for you.
— I would just mention this last, also, a personal philosophy…. for some it is good to develop a category in one’s mind called something like “God’s business,” for some things will never make sense, for things one cannot control or ever understand. Accidents are incomprehensible. Twists of fate often have little ‘rational fact’ to them. Evil things are by definition insensible. And some things, some events, some outcomes, will forever only be “God’s business…” understood and sealed in mercy by a Mind Greater. One that has mercy and love not only on those lost, but also on us.
— We all wish to be brave and strong in the face of sudden upheaval and disaster. We all wish to be looked up to for our endurance and our efforts to help others. If you truly care for humanity, then too, be sure to include yourself in their numbers, by giving your own inner feelings and thoughts the voice and the dignity they and you so deeply deserve.
And one last, last thing: worldwide there are strangers who are industrial strength praying men and women. We’ve got you on our radar and have already sent in the linebacker angels to watch over and guide you. We’re asking that you and all your loved ones be kept safe, that you see miracles during this time, and that you be made as whole as possible. We’ll keep the vigil candles lit. That’s our idea of fighting fire with fire.
In the meantime, please lean on our prayers.
Dr. Clarissa Pinkola Estés
This protocol letter for victims, survivors, helpers, family members, neighbors, law enforcement, fire-rescue, divers, workers and witnesses to massacre and disaster, “Recovery and Normal Reactions To Sudden Loss, Injury, and Catastrophe”; Copyright ©1970, 1999, 2001, 2006, updated 2007, 2009, Clarissa Pinkola Estés, Ph.D., All Rights Reserved, is printed here under Creative Commons License: author grants permission for free distribution under conditions that use be non-commercial, text be used in its entirety, and attributed with author’s full name and copyright.