[early draft, do not quote]

Clinical Implications of Troubles-Related Delayed Stress Reactions

By Charles R. Figley, Ph.D.

Florida State University

School of Social Work and the FSU Traumatology Institute

Abstract

This paper builds upon the previous paper that reviews briefly the state of knowledge about how traumatic experiences induced by national and internal violence are processed following periods of violence. Utilizing the same three theoretical models of trauma recovery, this paper suggests to policy makers, managers, and clinicians specific guidelines for the assessment, management, prevention, and treatment of post-Troubles-related traumatic stress reactions.

_______________________________________________________________

Clinical Implications of Troubles-Related Delayed Stress Reactions

Given the axioms noted in the earlier paper, in the short amount of time I have in this session, I would like to suggest that it is vital to prepare for a large number of people to seek assistance as peace begins to become a reality. I suggest the assistance should take place at four separate levels and, as such, would provide different assistance at each level.

National Level

Similar to efforts in Kuwait following occupation by Iraq and South Africa following Apartheid, there is an opportunity to educate the public about what the Troubles and the natural psychological and sociological consequences; that there may be both negative and positive consequences. But most importantly, any national message should touch and draw upon the common feelings of love, compassion, history, and pride shared by most citizens. There should be public education about post-Troubles emotional reactions and that these indicators are largely signs of healing, reconciliation, and resiliency. These messages would lead to a reframing or promotion of efforts to find and promote healthy sense of understanding about what happened during the Troubles, why it happened, why and how people behaved during the worst times, how and why people are responding to peace as they are now, and help anticipate the prospects of challenges to the peace process; not to allow a return to the mentality of violence.

Neighborhood and Group Level

These social systems organized themselves for mutual support and protection during the Troubles. During the transition period between war and peace, it is vital that these systems find new and equally important functions in times of peace. There should be efforts to retain close internal ties for mutual support, but at the same time, efforts to bridge the various social and cultural/religious gaps. This will be especially challenging since the struggles with death, violence, or the threats of either are learned responses and must be unlearned. To do this requires strong and courageous leadership. Creative efforts tried in the former Yugoslavia, particularly Bosnia and Kosovo and efforts to bring Palestinian and Israeli children together for mutual respect and understanding are worthwhile.

Family Level

Similarly, each family has their own history of struggling with the Troubles. Many have lost family members of friends of family members. These experiences run through the social fabric of families that form their identity, apart from others. Often grief and bereavement are intertwined with family rituals, stories, and traditions. Family milestones are often linked to some event linked to the Troubles. As family members seek in their own way to heal from their individual traumas they will be hindered or helped by other family members, vis-à-vis their own struggles. Sometimes family members find they must cut themselves off from one or more members in order to find the emotional energy to attend to their own mental health challenges including, but not limited to traumatic stress reactions. It causes considerable distress in family members and, in turn, triggers family reactions that counter efforts to withdraw.

What is vital here are professionals trained in family dynamics, family therapy, and couple counseling to help sort out individual versus systemic traumatic stress reactions and move the system toward rebuilding their future?

Individual Level

The individual level is perhaps the easiest and certainly the least complicated of the four levels. The three models can help practitioners become aware of how the individual has become aware of their post-traumatic stress reactions, if any. They can address the issues of secondary gain, resistance, motivation to face and recovery from past traumas, and identify the immediate and long-term positive and negative consequences of recovery from Troubles-related traumatic stress reactions. There are now a wide variety of treatment approaches available that address such issues as desensitization (unlearning the distress conditioned by trauma), the search for meaning, stress management, forgiveness (of self and others), resiliency, and education about post-Troubles adjustments.

Regarding the professional, the volunteer, and their organizations instrumental in helping the traumatized-- at any level of intervention, compassion fatigue burnout is an inevitable consequence of working in this area. It is a subject to which I will be devoting my attention all day tomorrow. I welcome your participation.

Conclusion

There is a great deal of cumulative understanding of how trauma is processed long after the traumatic event on an individual level. We know relatively nothing about how children, families, groups and entire nations process and recovery from trauma. Northern Ireland, composed of such creative and educated people, may become a living laboratory of creativity in these important areas. My hope is that your efforts be carefully documented and studied. The results should be reported in books, journal articles, special issues of journals, and other publications. The lessons learned here may way save lives here and elsewhere in the world for many, many years to come.

References (to follow)