[Early
Draft, Please Do Not Quote]
Troubles-Related
Delayed Stress Reactions:
Historical,
Theoretical, and Cultural Contexts
By
Charles R. Figley, Ph.D.
Florida
State University
School of
Social Work and the FSU Traumatology Institute[1]
__________________________________________________________
Abstract
This paper reviews briefly the state of knowledge about how
traumatic experiences induced by national and internal violence are processed
following periods of violence. Three theoretical models of trauma recovery are
applied and discussed in an effort to predict the impact of domestic terrorism
and violence. The paper identifies twenty-eight axioms that may be useful in
understanding the current state post-Troubles distress in Northern Ireland.
Implications of these axioms will be discussed further in the next paper.
_________________________________________________________________
Troubles-Related
Delayed Stress Reactions:
Historical,
Theoretical, and Cultural Contexts
Hopes for peace in Northern
Ireland are still strong. As an outsider with very little awareness of the
struggles during and following the Troubles here, I offer a perspective shaped
by the available research literature. Without comprehensive research directed
toward my topic today, I can only offer some observations drawn from my own
experiences and my reading of the research on this and similar situations.
Marie Smyth, in her book, Half
the Battle: The Cost of the Troubles (Understanding the impact of the Troubles
on children and young people), the Cost of the Troubles (COTT) Study found
that there have been 3,585 people killed in Northern Ireland between December
3, 1997 and 1969.
Among the dead 91% were male and
three quarters were of the dead were under 40 years of age. The death rate
among Catholics was 2.5 per 1,000 and among Protestants, 1.9 per 1,000.
Responsibility for these deaths is largely due to paramilitary forces (59% by
Republicans, 28% by Loyalists).
In addition to the COTT study
there has been the highly influential We Will Remember Them, a Report of the
Northern Ireland Victims Commission by its Commissioner, Sir Kenneth
Bloomfield, KCB (April, 1998). Also there is the Health Service report of the
Social Services Inspectorate: Living with the Trauma of the 'Troubles' (March,
1998). Both reports call for much more attention to the psychosocial and
emotional needs of the traumatized including but not limited to those directly
in harms way.
Special Characteristics of the Troubles
In reviewing the characteristics
of the Troubles, it appears to include the following seven characteristics:
- Traumatic
stressors are domestic (versus foreign). As a result, the
reminders of the original trauma are constant and the treat of
re-traumatization is real. On the other hand, there is greater opportunity
for permanent desensitization once peace is firmly established, since
reminders of the trauma will be supplanted by neutral or positive
experiences. This is in contrast to war veterans returning to the scene of
combat many years later and activating distress long forgotten.
- Threat
is everywhere and continuing now (versus limited to only a certain area in
the past). As a result, fear and caution is an
appropriate survivor response. Assessment and treatment of the traumatized
must not eliminate vigilance. Rather, the focus should be on proper stress
management and differentiating real versus irrational threat.
- Threat
is assumed to be associated with those who are different in terms of
culture (i.e., religion) and not any obvious differences (e.g., skin
color). As a result of this characteristic, there is a
greater tendency toward prejudice, hatred, demonization, and
marginalization. This is a well-researched phenomenon of stereotyping and
selectivity in person perception, biases in attribution, social
attraction, in/out group formation, and rules of conformity.
- The
domestic strife extends for more than one generation (versus a single
incident or quite recent situation). As a result of this
characteristic, it will take generations to fully erase the lack of trust
between groups, unless any program of national trauma reduction includes
efforts to correct the cultural prejudices and mistrust. The same
challenge faces Israel and Palestine, the Hindus and Muslims in India, the
Hutus and the Tutsis in Rwanda, and elsewhere around the world. The
differences here is that high level of sophistication of the people of
Northern Ireland with such a rich history of hard work and creativity.
- Rituals
and artifacts remind and reinforce inter-group hatred (rather than limited
to the memories of some). They are quite evident to
everyone, including those of us from abroad: The painted curbs, the walled
in neighborhoods, the posters and murals communicate who is welcome and
who is not. They function well in times of war. Just as the sticking points
to the peace accord have been disarmament, so will abandonment of these
rituals and artifacts to lasting peace and an end to the traumatic
reactions of its people.
- Outside
forces tend to modulate tensions (versus attending exclusively to internal
stimulus). Former Senator Mitchell has always said he is
an instrument to the wishes of the people who seek peace. Yet, third
parties are vital here as they are everywhere people are divided
internally. It will require outsiders in peace as well to help heal the
wounds of the Troubles. Yet, there must be a commitment to healing that
follows a commitment to being healed from the hatred and suspicions of the
past.
- Peace
efforts affect hope for reconciliation and signaling of letting go of our
fear and defensiveness (versus no peace effort and hopelessness).
Just as the Palestinian Authority is hopeful about peace in spite of the
election of someone they so revile as Sharon for his hostile actions and
attitudes toward them, it is their salvation. And after peace does finally
arrive there as we all hope it has arrived here, hope is for
reconciliation and with it resiliency at a personal and social level.
Axioms of Post-Troubles Recovery
Based on my familiarity with
contexts like the Troubles, I would make the following observations:
- Peace
leads to a period of transition from a state of readiness and numbness to
a state of hope and freedom.
- This
is the first post-traumatic period I have described as the second wave of
trauma and a period of "relief and confusion" (see Figure 1).
- It
is characterized by relief about increased safety but confused about all
that had happened during the state of distress and trauma (e.g., the
Troubles).
- In
Wave I (crisis) there is a state of war. One is conditioned to prepare for
the worst, to not feel hope, and to hunker down emotionally and socially.
- As
hope surfaces that a state of war will end and a state of peace will
begin, any set backs will discourage hope. There is a constant moving
forward and backward among the initial waves.
- As
sense of peace becomes a routine the reactions so appropriate in a state
of war become superfluous and irrational. There is less and less return to
the initial crisis period and great disparity among the survivors.
- Left
unattended, these survivor-oriented reactions interfere with the quality
of life.
- Gradually,
the survivor enters the third wave of avoidance as a reprieve against
constantly thinking about the Troubles and the past.
- Eventually,
within months of the post-trauma period, many survivors move into the
fourth wave, period of Reconsideration.
- This
period includes the various symptoms of acute stress reactions and
post-traumatic stress reactions that include, but are not limited to
ü
Re-experiencing the traumatic memories of past
traumas
ü
Shutdown in emotional responsiveness in
anticipation of or in the process of struggling with these memories,
ü
Increased arousal and startle reactions
associated with the reminders
ü
Avoidance of reminders of the trauma in order to
avoid the unwanted negative reactions;
ü Impairment
in social, occupational, and other functioning caused by the struggles with
these memories and delayed reactions to them.
- People
and families will vary in entering into the final wave, their willingness
to recognize and do something about their trauma: The memories and
associated symptoms. It is at this point years after peace is a reality
here that the most traumatized people will need help to make the final
journal into recovery.
- The
purpose of attending to Troubles-related trauma is to finding meaning that
improves the quality of life now and in the future.
- Figure
2 is a kind of road map for understanding the entire trauma induction,
reduction, and learning process.
- Experiencing traumatic stress reactions
is analogous to being obsessed.
This is an alternative way of thinking about trauma apart from a
more medical model that views traumatic stress reactions as an illness)[2].
- Being
possessed means being held captive by our experiences until we are able to
learn from the past; to be free of being possessed when we have found the
meaning that enables us to thrive in our world not just survive our
experiences.
- Being traumatized is also analogous to
being phobic[3] about
certain things associated with the trauma. As a phobic organizes their lives
around the limitations imposed by the phobia, so do the traumatized.
- The cure for these difficulties is
facing the fears, learning from them, and applying the lessons to the
future.
- Easier said than done.
- Yet, the most difficult traumatic experiences
are associated with death.
- Consistent with the Figley & Rando
Model of Loss Accommodations (Figley, 1997), those who have experienced a
major loss have a far greater set of challenges.
- This
can be illustrated in Figure 3.
- Appraisal
of loss by the grieved is associated with either normal grieving (death
was expected, timely), trauma processing apart from and in the absence of
grieving, or processing both the trauma and the loss simultaneously (most
typical).
- Each
is associated with a non-specific arousal (symptoms) reduction process
that is either professionally or non-professionally facilitated.
- Loss
accommodation evolves over time through the re-working of new information
about the beloved in the process of self-soothing and desensitization
processes.
- Loss
accommodation includes “six functions of the mourning process"
(Rando, 1993). These Sextet ("R") Functions to recovery from
trauma and loss are:
(1)
Recognize the loss
(2)
React to the separation
(3)
Re-experience
the deceased and the
relationship
(4)
Relinquish the old attachments to the deceased and the old
assumptive world
(5)
Readjust to moving into the new world without forgetting the
old
(6)
Reinvest in the new world
- Finally,
another group that was exposed to the Troubles and who may not be able to
fully separate from those memories, despite lasting peace are YOU.
- Northern
Ireland counselors, lawyers, nurses, physicians, reporters, managers and
policy makers must visit and revisit not only their own personal
experiences of the Troubles, but also those of the survivors for whom they
treat and work.
- The
same factors of recover in the models noted earlier apply equally to the
professionals who work with the traumatized.
Discussion
of the Clinical and Policy Implications
What ARE the clinical and policy
implications of the points I have made this morning? I hope to discuss them in
my next paper, this afternoon. For now, let me make these observations based on
my experiences in South Africa. Following the end of Apartheid in 1993,
President Mandela established the Commission on Truth and Reconciliation. It
was composed of a dozen respected academics, members of the religious
community, politicians, and lawyers. The purpose of the Truth Commission was to
bring reconciliation of all citizens through an airing of the truth by both the
victors and the vanquished, by the perpetrators as well as the victims. Over a
four-year period of time the Commission split into several subcommittees and
groupings and held hearings all over the country. Every minute of these
hearings were recorded. Most were shown nationally, some of the more notable
sessions were shown live nationally. In the end they produced a massive
document that fully described what happened during the thirty years of
bloodshed, horror, and brutality. Hundreds of people testified. Some sought and
were granted amnesty. Some sought and were granted compensation. By and large,
however, the true benefits of the Commission could be seen in the signs of
hope, reconciliation, and healing throughout the country. South Africa remains
a poor country and still divided along racial and ethnic lines. Yet, few would
have predicted how smoothly the post-Apartheid transition period has gone. It
is remarkable that so few people have been killed out of revenge and racial
hatred.
Though not perfect, South Africa
provides a beam of hope to all people so divided for so long that a traumatized
nation, with the right people and the right plans, could heal. As the words of
Mandela suggest, in his Long Walk to Freedom (Mandela, 1994) talks about hope,
mercy and generosity.
No one is
born hating another person because of the color of his skin, or his background,
or his religion. People must learn to hate, and if they can learn to hate, they
can be taught to love, for love comes more naturally to the human heart than
its opposite. Even in the grimmest times in prison, when my comrades and I were
pushed to our limits, I would see a glimmer of humanity in one of the guards,
perhaps just for a second, but it was enough to reassure me and keep me going.
Man's goodness is a flame that can be hidden but never extinguished (p. 622).
References
Dovido, J. F. and Gaertner, S. L. (Eds.) (1986). Prejudice,
discrimination, and racism. NY: Academic Press.
Figley, C. R. (Ed.) (1997). The Traumatology of grieving.
Philadelphia: Taylor & Francis.
Kleber, R. J., Figley, C. R., and Gersons, B. P. R. (Eds)
(1995). Beyond trauma: Cultural and societal dynamics. NY: Plenum Press.
Mandela, N. (1994). Long walk to freedom. Boston: Little,
Brown & Company.
Rando, T. (1993).
Smyth, M. (1997).
Mapping Troubles-Related Deaths in Northern Ireland, 1969-1998.
Figure
1: Waves of Recovery Model
Figure
2 Trauma Processing Model
Figure
3: Loss Accommodations Model