Given the events of the last few months, and most recently, the tragic shooting in Las Vegas, we would be remiss to not discuss how traumatic events affect us as expats living abroad. This topic is diverse and far-reaching, thus, I am going to write a couple of blogs focusing separately on the experiences of trauma in-person and second-hand. For this blog, I want to discuss secondary trauma, which is experiencing a traumatic event indirectly. This is what happens to us as we view and absorb shocking, disturbing, or life-threatening events through the news, social media, or from someone we know. For expats specifically, we often see and hear about these traumatic events as they relate to our home country, family, and friends while being oceans away.
The Las Vegas shooting is the most recent example of secondary trauma for American expats. Just in the last few days the world has learned of a man, with unknown motivation, opening fire indiscriminately on a crowd of people enjoying a concert. The victims and survivors of this traumatic event came with family and friends to get a break from work and ‘real life’ in order to enjoy good company and country music in the heart of a city built on life, freedom, fun and excitement. Little did they know the tragedy that was about to unfold.
More broadly, it seems that whenever we read or watch the news there is always a traumatic event that is looming. We have become accustomed to seeing terror attacks unfolding in the world from in France, the UK, and Sweden, to ongoing humanitarian and political crises that seem to be never-ending in many parts of the globe. Hurricanes, earthquakes, and other natural disasters have also ripped through islands, states, and territories, forever changing the lives of their people. These traumatic situations have destroyed homes, separated families, and claimed the lives of far too many people.
What is crucial to understand from all of this tragedy, is what happens to the people left behind around the world. Those who remain have their sense of physical and psychological security changed and potentially shattered because of what they have seen, heard, and understood. Natural disasters are often seen as unstoppable, unpreventable, forces of nature or divine occurrence. It doesn’t make the devastation easier, but understanding that we could not have changed the outcome of the situation does help the healing process tremendously by allowing us to move on from feeling guilt or personal responsibility. In this case, community and government response is often the focus of response and intervention to rebuild afterwards.
Mass casualty situations that occur as a result of domestic or international terrorism, or the acts of a mentally ill person area a different story, as there are so many variables that can affect the outcome. Thus, they can be especially jolting to our sense of security and well-being. Unlike hurricanes on the coast, we may wonder afterwards if an attack could happen at any place or any time, and under any circumstance. We begin to negotiate our sense of the world as ‘dangerous’ or ‘safe’ and ‘good’ or ‘bad.’
The Role of Fear in Trauma
Let’s take a second here to talk about the biology of fear, because it plays a huge role in our immediate response to traumatic situations. Fear is a powerful but normal feeling. It is what drives survival, adaptation, and the ability to do incredible things in difficult situations. Of course, we experience fear during a traumatic event like a hurricane or a shooting, especially if we are there when it happens. In this case, fear prompts our brain and body to react to in a way that protects us from the danger we are facing. How does this work? When we experience a traumatic event our brain chemistry literally changes in an instant via the fight, flight, or freeze response. This chemical reaction in the body creates a surge of adrenaline and other powerful hormones to get you moving out of danger. Sometimes though, this response is overwhelming to us, which is when we experience paralyzing fear and the inability to move or respond.
We also cope with fear, though in a slightly different way, when we learn of these events and see them in the media. We may not experience the same initial level of biological response, but we can experience similar horror, shock, and lack of safety, which can lead to similar problems in coping.
Secondary Trauma
Witnessing traumatic events second-hand is in many ways similar to direct trauma, because it still involves exposure to the tragedy and can invoke intense emotional reactions. However, secondary trauma exposure has some distinct differences. One of the primary ways it is different, outside of being an indirect exposure, is that it may be more continuous than direct exposure. The news and social media tend to share horrific videos and images, including sounds of screaming, images of dead or injured persons, and detailed stories from survivors on a loop. This continued exposure to traumatic material can have different effects on different people. For many of us when the tragedy occurs in the US, we can identify with the victims and the survivors. Perhaps we know someone who was there or close-by. Immediately we may wonder, “What if that was me?” “What if my loved one was harmed or killed?” “Could that happen to me here?” “What is going on in the world to make this happen?” “Who is responsible?” “Why did they do it?” “Who is at fault?” “How could this have been prevented?”
Normal Reactions to Traumatic Events
Everyone reacts when bad things happen, and we want to recognize here that having strong emotions, difficulty eating, sleeping, and even the inability to engage in your everyday life in the weeks following a traumatic event is NORMAL. When you strip it down, traumatic events force us to consider that we could cease to exist at any moment despite our best efforts. For most people, this leads to a series of overwhelming emotions, including feeling temporarily confused, anxious, angry, hostile, hyper-vigilant, deeply saddened, or lost. Numbness, shock, and apathy are also common feelings in the wake of traumatic events. For some people, their very sense of safety and meaning are shaken. For these people, coping can mean identifying the perpetrator of the traumatic event (person, group, law, country) and seeking justice from law enforcement or government officials.
A Note on Posttraumatic Stress Disorder (PTSD)
It is important to know when to seek professional help in the wake of trauma. Struggling after a traumatic event is normal until about one or two months post-trauma. Most people will be able to return to their normal lives and routines within a month or two of the event taking place, provided there are no extenuating medical or environmental circumstances that prevent this from happening. This does not mean that you do not have any lingering feelings, questions, or difficulties. What it does mean, is that most people are able to function in a regular routine and are able to start making sense of things after the first couple of months. After this point, doctors and mental health professionals begin to assess for and treat posttraumatic stress disorder (PTSD) if significant problems continue to occur. If you or someone you know continues to have significant difficulty making sense of what happened, cannot sleep, are struggling with emotional regulation, keeping up with daily life demands, or find that you are relying heavily on alcohol or drugs to cope, please reach out to a professional.
The Cumulative Effect of Trauma
After the initial shock has passed, traumatic events begin to affect everyone differently. This is especially true for people who have experienced more than one traumatic event in their lives because trauma reactions are cumulative. So, if a person has experienced a traumatic event in the past, subsequent trauma will have an additive effect on them. For example, if a person who was present for the Las Vegas shooting was also in a life-threatening car accident previously, they are at a much higher risk for continuing to have problems coping than someone with no trauma history. This effect is known as “triggering” or “being triggered.”
For someone with prior traumatic experiences, any type of new traumatic event can be triggering, even if it is secondary exposure. If a person is watching a traumatic event unfold on television that is similar to what they have experienced in the past, their fear response can be activated as-if they were there in person. Persons who have been triggered can look and act just like people who are immediately post-trauma. It’s important to check-in with a primary care physician or a mental health practitioner if these reactions continue, become overwhelming, or begin to affect daily living.
It’s also important to know that secondary trauma can also trigger emotions that may seem unrelated to the traumatic event. For example, if a person has recently experienced a death in the family, or a significant loss (e.g. painful divorce), that person is feeling significant emotional pain and sadness. The person may already be feeling alone, isolated, unsure or insecure. Viewing traumatic events may only seem to reinforce those feelings of sadness, instability, and uncertainty in how they view themselves and the world. They may thus experience more distress in the short term.
Secondary Trauma in Children
For children, secondary trauma can be disconcerting and especially confusing, but it is important to acknowledge it. For young children who do not understand their environment or time, they may be fearful that these traumatic events are occurring as separate events, over and over again, each time they happen to glimpse it on the news. They may even believe it has happened down the street or believe it is ‘pretend’ as a way to cope with what they are viewing.
Keep in mind your child’s age, maturity, and language when trying to explain events. It is important to be honest about what has happened, but not vivid in descriptions. Consider giving them a “newspaper headline” of what happened, and as the age of the child increases, add a few more ‘lines.’ For example, you may tell your 6 year-old, “A man has done some horrible things in the state close to your grandmother. The police are working very hard to figure it out, and keep it from happening again.”
However, for your 11 year old you may say, “A man has killed many people in Las Vegas. No one knows why he did that and it makes things really confusing for everyone, including me. Several people have died, though many people are safe now and getting help they need in hospitals. The police are working very hard to determine how and why it happened. Even law-makers are considering new laws to prevent these things from happening again. We are safe here, and we do our best to be sure we are safe wherever we go. There were many regular people who turned into heroes when this shooting occurred. It is important to know there are also very good people in this world.”
Healing in the Wake of Traumatic Events
There are some things we can do to protect ourselves and those around us in the wake of traumatic events. Primarily, creating and utilizing a social support network is key to creating a sense of unity and safety for all of us around the world. When we grieve together, collectively, as a community, culture or globally, it is healing for those who have endured the traumatic events. It is also helpful for us who are removed from the events to feel connected.
For some people, it is helpful to hear survivor stories, but it is definitely okay to limit your exposure if it becomes overwhelming. What is important is no matter where we are not ignore the tragedy or pretend it didn’t occur. It may also be helpful to use the devastation we feel in a way that gives us back some semblance of control. We can talk with family and friends, educate ourselves on the events and how to prevent them in the future, contribute to a charity, volunteer at a hospital, or become social or political activists.
We as people are powerful survivors, as most of us will endure some form of trauma or loss throughout our lives. Despite this, we can adapt, heal, and go on to live healthy and productive lives. Sometimes, it is because of the tragedy that we find hope, purpose, and a new sense of meaning and determination. We emerge as strong, changed, individuals experiencing deep personal growth with the potential to evoke powerful socio-cultural change.
Remember that you too are a strong and important person, no matter what your circumstances are or what you have been through in your life. You matter, you are worth taking care of, and your mental health is important to invest time into. Take time for yourself, spend time with those people who matter to you, and share your reactions to what is going on in our world with those around you. If you are finding that you are one of those people who is having continued difficulty getting through each day, we are here for you. Please reach out if you need anything in the wake of this recent tragedy, or if there is anything in the future we can help you with. You can visit our website at www.therapysolutionsabroad.com, email us at info@therapysolutionsabroad.com, or call us at +1 434-381-0604. Take care!
Best,
Dr. Sanness