Editor's Notes

1. This does not discount the impact the individual’s pre-trauma worldview, belief system, values orpersonality has on the interpretation of the trauma, but it does indicate that the individualis not inherently weak or inferior. Rather, it indicates severe trauma and stress createweakness in the individual, and not the reverse. (Matsakis, 1996) A trauma is awounding, thus individuals suffering PTSD are injured, not mentally ill, even thoughdiagnosed with a disorder from the DSM. This is confusing for mental healthpractitioners and laypersons alike. But the distinction is important if mental healthpractitioners desire to assist a traumatized client. (Field, 1996; Namie, 2000; Namie,2006; Hunter, 2007)
2. Feelings, and the physiological reactions to these feelings, becomepatterns of anticipation, which in turn create more maladaptive feelings. Thus there is amutual interaction between the two that promotes “isolation and paralysis of themind”(Holter, 2005, abstract).The dehumanising aspect of the trauma creates feelings of not having a right toexist and promotes a sense of being a fraud because the individual, although actually ahuman, no longer feels connected to humanity and the human race. Treatment, therefore,becomes difficult because of a lack of trust, isolation from society, and a fear of feeling.(Currim, 2004; Hunter, 2007) Part of the dehumanising of the trauma is the “breakdownof cathexis, i.e., the failure of empathic connection at the time of the trauma”…resulting in“an inability to keep upright an inner empathic, emotional connection” (Holter, 2005,
3. PTSD is often thought of as a war injury, yet an online survey conducted by theNational Center for PTSD (U.S.) reveals only 32 percent of respondents acquired thedisorder from war experiences. The majority of respondents (48 percent) are traumatizedthrough various forms of abuse (spousal, childhood, sexual, bullying). The statisticscontinue with 19 percent from crime, 18 percent from accidents, 8 percent from acts ofterrorism, and 5 percent from natural disasters. (NCPTSD, July 4, 2007)NCPTSD. (May 22, 2007). FAQs about PTSD assessment: For professionals. RetrievedJuly 4, 2007, fromhttp://www.ncptsd.va.gov/ncmain/ncdocs/fact_shts/fs_prof_faqs_assessment.htmlNCPTSD. (June 1, 2007). How common is PTSD? Retrieved July 4, 2007, fromhttp://www.ncptsd.va.gov/ncmain/ncdocs/fact_shts/fs_how_common_is_ptsdhtmlNCPTSD. (June 25, 2007). Helping a family member who has PTSD. Retrieved July 4,2007, from http://www.ncptsd.va.gov/ncmain/ncdocs/fact_shts/helping_a_family_member.htmlNCPTSD. (July 4, 2007). PTSD today? Retrieved July 4, 2007, fromhttp://www.ptsdinfo.org/Not all trauma leads to PTSD. In fact, most people who experience a trauma donot develop the disorder. Sixty percent of men and 50 percent of women experience atrauma severe enough it might lead to PTSD. Yet only an approximately 8 percent of menand 20 percent of women will have a maladaptive reaction to the trauma and meet PTSDcriterion as listed in the DSM-IV-TR. Risk factors include being a victim of or witness toa traumatic event that was long lasting or severe and caused serious injury or danger.Feelings of helplessness and a severe reaction such as crying, shaking, vomiting, anddissociation are important contributors. (Schupp, 2006; NCPTSD, June 1, 2007)This disorder was first described in Vietnam War veterans, but has also been called "battle fatigue" and "war neurosis" in past wars. More than 50 percent of combat veterans may experience some form of PTSD, although the milder forms may not be diagnosed or treated. Combat veterans tend to experience more severe forms of PTSD because the duration and severity of trauma during war is greater, but the disorder is frequently diagnosed in civilians who have experienced and survived serious trauma. For example, the victims of serious accidents, rape survivors, people burned out of their homes, survivors of other natural disasters such as tornadoes, hurricanes and earthquakes, and violent crime victims all may develop PTSD. In each of these events, the threat of death or serious injury is present, and those who develop PTSD realized, or believed, that their lives were on the line.
4. Because PTSD creates a constant state of intense stress the body’s reaction to thiscauses neurobiological changes. Glucocorticoids, epinephrine, and norepinephrine pulsethrough the body as part of the normal reaction to stress. These chemicals are importantfor human survival but excessive amounts cause the brain to malfunction. Because ofhyperarousal, the body of an individual suffering from PTSD gets too much of thesechemicals, even when no threat is present. The chronic stress promotes physical ailmentsand a breakdown of the immune system. Other difficulties include increased heart rateand blood pressure, changes to the distribution of cortisol (affecting mood and energylevels), shrinking of the hippocampus (affecting learning and memory), and enlargementof the amygdala (affecting emotional behaviours). (Horowitz, 1999, as cited in Schupp,2006; Resick, 2001; Pinel, 2007; Hunter, 2007)
5. Dissociation interferes with the client’s ability to process appropriate meaning, thus respond appropriately, aswell as verbalize the events and their meaning. (Messler Davies, 1997; Hunter, 2007)Treating the symptoms of PTSD is not sufficient. Because of the destruction ofthe sufferer’s sense of self and ability to relate to themselves and others in a healthymanner, the symptoms are “linked to a dissociated representational memory system whichis implicated in”…a “profoundly negative self-perception” (Parson, 1998, abstract). Thisis demonstrated by dissociative behaviours and emotional swings, partly connected to thebi-phasic arousal states. (Parson, 1998, Schupp, 2006) Although cognitive behaviouraltherapy will meet with some success it is important the therapist promotes post-traumaticintegration of the trauma memories and the “new normal” in which the individual withPTSD lives. This needs to be done through “mutual relational dynamics” (Parson, 1998,abstract) within a trusted client–counsellor relationship. (Matsakis, 1996; Parson, 1998;Schupp, 2006; J. Douglas, personal communication, May 15, 2007)
6. Due to the fragmentation of the sense of self, This is essential because horrific trauma is dehumanising and in order to come to terms with the trauma the victim dissociates, which impairs perception of identity and personhood. Thebi-phasic response in relation to allostatic load perpetuates maladaptive stress responses.
7. In cases of sexual harassment, retaliation, and other forms of employment discrimination. First, the contribution experts can make by presenting a framework to assess and understand the nature, duration, intensity and severity of emotional injuries is outlined. Specialized knowledge helpful in assessing these claims is reviewed in light of the scientific literature on stressors, anxiety disorders, somatoform disorders, depression, posttraumatic stress disorder, and ways in which related symptoms manifest regarding events in the workplace or following loss of employment. Second, the role of qualified experts to facilitate determinations of causation is discussed, highlighting factors that bear on preexisting harm, intervening injurious events, the exclusion of alternate sources of mental distress, emotional harm and humiliation, and mitigation of damages.
8. This leaves the individual vulnerable to triggers that bring on a re-experiencing of the trauma,in effect over the long run, intensifying the trauma. (Wilson, et al., 2001) The allostaticload and resulting bi-phasic arousal response do not allow for an escape from the reactionto the trauma. There is also a concern of the client developing Learned HelplessnessSyndrome. (Seligman, 1975, as cited in Matsakis, 1996) This can only be “counteractedthrough learning and changes in the social structure” (McEwen & Wingfield, 2003,abstract)Since anxiety is part of PTSD, teachers and parents need to be aware of a traumatized individual’s difficulty inprocessing information. This is also linked to Maslow’s (1970) hierarchy of needs.According to his theory “being needs”, the three higher-order needs, cannot be met untilthe “deficiency needs”, the four lower-order needs, are met.
9. This is also linked to Maslow’s (1970) hierarchy of needs.According to his theory “being needs”, the three higher-order needs, cannot be met untilthe “deficiency needs”, the four lower-order needs, are met.PTSD changes the diagnosed individual’s life and greatly impacts the lives ofthose with whom they are close and regularly interact. The explosive rage, depression,isolation, anxiety, cognitive difficulties, and lack of vitality combine to cause loved onesto question if life will ever return to normal. Families and teachers can best help theindividual with PTSD by learning about the diagnosis and levels of victimization so as toavoid secondary wounding and enabling behaviour. A strong support network is essentialfor healing and families are an integral part of that network. Trusting relationships areessential to combat the dehumanizing effect of trauma. Also, according to the WorkplaceBullying and Trauma Institute findings (Namie, 2000) it is the most competent employeeswho tend to be targeted and 82 percent of those targeted either voluntarily or involuntarilyleave their jobs. (Namie, 2000; Blasé & Blasé, 2003; Namie, 2006)Because of the dehumanizing nature of trauma it is important that treatmentapproaches deal with the client holistically as opposed to treatments designed solely toreduce symptoms. (Wilson, et al., 2001) Mental health practitioners need to be aware ofthe criterion found in the DSM-IV-TR as well as the various ways to measure traumaexposure. However, in determining a PTSD diagnosis it is important to be aware thatsomeone suffering from PTSD has honed avoidance strategies and may not be able toverbalize their experience. (Hunter, 2007; NCPTSD, May 22, 2007)Many therapists practice narrative therapy believing this is essential to overcomingthe trauma. However, this approach may be harmful for some clients suffering fromPTSD. According to Schupp (2006) some clients do better never narrating the trauma andshould instead focus on coping techniques to deal with triggers. Because of the reexperiencingaspect of PTSD, grounding strategies to assist the client in remaining in thepresent are important. (Matsakis, 1996; Foa, Keane, & Friedman, 2000; Wilson et al.,2001; Schupp, 2006; Hunter, 2007; J.Douglas, personal communication, May 15, 2007)Grounding techniques are an important part of emphasizing that the current experience offear is an illusion. (Kopp, 1988; Wilson, et al., 2001) Other therapy strategies, such as debriefing, cognitive behavioural therapy (CBT),eye movement desensitization and reprocessing (EMDR), resource development andinstallation (used in conjunction with EMDR), psychodynamic therapy, emotionalfreedom techniques (EMT), exposure therapy, gestalt therapy, traumatic incidentreduction therapy (TIR), a form of neurolinguistic programming called visual/kinestheticdissociation (V/KD), logotherapy, visual imagery, various forms of creative therapies (artand journal), and hypnosis are used for treating PTSD. (Matsakis, 1996; Foa, et al., 2000;Wilson, et al., 2001; Schupp, 2006; Hunter, 2007) Hunter, 2007, feels hypnosis isineffective and damaging to clients with PTSD and should never be attempted, whereasothers view hypnosis as effective for reducing the anxiety associated with PTSD. (Daly &Wulff, 1987, as cited in Foa et al., 2000; J. Douglas, personal communication, May 15,2007)Because of the dehumanizing nature of trauma it is important that treatment approaches deal with the client holistically as opposed to treatments designed solely to reduce symptoms. (Wilson, et al., 2001) Mental health practitioners need to be aware ofthe criterion found in the DSM-IV-TR as well as the various ways to measure traumaexposure. However, in determining a PTSD diagnosis it is important to be aware thatsomeone suffering from PTSD has honed avoidance strategies and may not be able toverbalize their experience. (Hunter, 2007; NCPTSD, May 22, 2007)Many therapists practice narrative therapy believing this is essential to overcomingthe trauma. However, this approach may be harmful for some clients suffering fromPTSD. According to Schupp (2006) some clients do better never narrating the trauma andshould instead focus on coping techniques to deal with triggers. Because of the reexperiencingaspect of PTSD, grounding strategies to assist the client in remaining in thepresent are important. (Matsakis, 1996; Foa, Keane, & Friedman, 2000; Wilson et al.,2001; Schupp, 2006; Hunter, 2007; J.Douglas, personal communication, May 15, 2007)Grounding techniques are an important part of emphasizing that the current experience offear is an illusion. (Kopp, 1988; Wilson, et al., 2001)Other therapy strategies, such as debriefing, cognitive behavioural therapy (CBT),eye movement desensitization and reprocessing (EMDR), resource development andInstallation
10. Because PTSD is “soul murder” (Schupp, 2006, p.59) and splinters the sense of self, the acute mistrust in the individual’s environment and possible co-morbid issues,such as depression and anxiety, can lead to social isolation and a decrease in socioeconomicstatus. (McEwen, 2000) The loss of human potential is incalculable.North American society has a tendency to blame the victim for not being able tosimply “get over it” and this cultural lack of support can be classified as secondarywounding and promotes a victim mentality, thus keeping the problem going. (Matsakis,1996; Namie, 2006) Additionally, our Canadian justice system views crime as occurringnot against individuals but against the crown, or society as a whole. This attitudereinforces the depersonalization of trauma and encourages PTSD among victims of crimeand reinforces their lack of human value in our disposable society. (S.B. Monaghan,personal communication, June 3, 2006)ConclusionsTrauma is destructive. But is there an upside to trauma? Some theoristsclaim there might be. Walsh (1985) feels trauma causes individuals to look inward and bylooking inward they become more in touch with their humanity and more able to reach outto others, thereby promoting a more complete human community. Wilson, et al. (2001)hopes that the “healed self that was once traumatized can project itself into the future withjoy, serenity, and a measure of wisdom” (p.12).Currently our society does little to support those suffering from PTSD. A changein attitude is essential if human potential is to be realized. Individuals, once healed, are“potential guides, healers, teachers, and may be subjects of scientific inquiry concerningresiliency, salutogenesis, and self-efficacy” (Wilson, et al., 2001, p.13). Our society viewsmany objects as disposable and when an object is tarnished or dented the tendency is todeem its value gone, throw it away, and rush to the stores to replace it. Humans are notobjects, and the growth potential available though the healing process is infinite.If the client is viewed, and learns to view his or her self, holistically, he or she is moreable to restore “a meaningful sense of self-sameness and self-continuity which”…promote feelings of “worth, dignity, wholeness, purpose, and an essential feeling ofvitality” (Wilson, et al., 2001, p.12).
11. (Wilson, et al., 2001, p.13).