Letter to A Survivor of A Recent Trauma
By Brigitta Karelis, MA, LPC ©
November 2017, updated January 2023
After a ferry accident, half of the survivors were given one sheet of paper. On this one page were listed some symptoms they might expect following this disaster, and some suggestions as to how to take care of themselves. The other half of the survivors did not receive this information. Six months later, the survivors who had received this one page fared much better than the ones who hadn’t. I never forgot this report, and to this day, I have been very taken by it: how easy can it be! To help a little bit! While we don’t know if it was the information itself that helped the survivors who had received it, or simply the act of receiving it as an acknowledgment of their experience: the result was remarkable. Where are such sheets of paper for survivors of current traumas?
In November 2017, I was asked to provide information and guidance to someone who had been injured in a crowd that got out of control, and wrote the first version of this letter to them.
In November 2018, hearing about the mass shooting in Thousand Oaks, California, and being contacted by an affected friend, I felt compelled to make this information public. While it is longer than one page, it is my sincere wish that it benefits survivors of a recent trauma, as well as, possibly, their friends, family, and community, in a way similar as the single sheet of paper benefited the survivors of the ferry accident: acknowledge your experience, give you a bit of a roadmap for the new landscape you are finding yourself in, and point to tools for good self care.
There are many kinds of trauma, such as accidents, medical trauma, natural disasters, relational trauma such as emotional, physical, and sexual abuse, single-incident versus multiple incidents, chronic threat, etc.. There is trauma that happened a long time ago, that happened recently, and that is happening currently, each affecting us in its own way. Each category of trauma, and each survivor, deserve their own unique approach. This letter does not address any particular category of trauma per se. It is meant to provide basic information to help alleviate the suffering that is common in most traumatic experiences, while understanding and respecting the immense complexity that comes along with surviving and recovering from trauma.
Most information in this letter is taken from several sources and may be found in other places. The main source is the material taught by the Sensorimotor Psychotherapy Institute, for which I taught internationally from 1999 through 2018.
May it bring benefit.
Dear survivor of a recent traumatic experience,
Some information about trauma – what it is, what to expect, and how to take care of oneself in the aftermath – has shown to relieve symptoms of traumatization, and help cope with the effects of the event. May the information contained herein serve you to carve out your path towards integration of what happened to you, so you can move forward in your life in healthy and constructive ways.
First of all, what does “trauma” mean?
Freud defined trauma as an experience that renders one feeling helpless and overwhelmed. Trauma is a major breach in one’s physical and / or emotional boundaries. Boundaries pertain, among other things, to safety. For whatever reason, one can’t keep oneself safe, can’t protect oneself. With a single event trauma, such as accidents or shootings, it usually happens suddenly and unexpectedly. In these cases, trauma is a severe disruption, interruption, of the life that one was just living, and sets the survivor instantly on a new course of life. Other traumatic experiences might happen repeatedly and over a period of time, like some kinds of childhood trauma. Yet other people, especially marginalized people, live with chronic traumatic stress, a daily threat to their identity, well-being, safety, lives. In all cases, one's personal boundaries are challenged, threatened, or outright violated.
What makes something more, or less, traumatizing to the survivor depends on many facets. These facets fall under three large categories:
The person who experiences it (for example, their age, physical resourcefulness, previous experiences, spiritual beliefs).
The specifics of the event (how long it took, was it once or repeated, were you alone, was it accidental or was there intentional harm, etc.), and
The response and level of support of the environment.
Within these three categories, there might have been elements that contributed to the traumatization. These are vulnerability factors, such as being of a young age. There were also, quite likely, elements that helped. These are resiliency or resource factors. They are the elements that helped you make it through. Without minimizing the level of hurt, damage, devastation, and traumatization at all, it is very worthwhile to take good note of, and treasure, the resources that helped you during and / or after the event(s). That in itself can help mitigate the negative effects.
Due to these many intertwining factors, one’s experience is always multifaceted, unique, and very personal.
The issue therefore is not so much what exactly happened, but if it left you traumatized, and if so, how much and in what ways.
Symptoms of Traumatization
According to the DSM 5, from the event on until one month after, one’s symptoms might fit the diagnosis of ASD, Acute Stress Disorder. Symptoms that persist or develop later fall under PTSD, Post Traumatic Stress Disorder. One might say that these are actually not disorders at all. They are natural consequences, when your life and your very being have just been forcefully, violently yanked off course.
Possible symptoms of PTSD include
Intrusive experiences.That means you might have nightmares, or flashbacks, where the traumatic experience is suddenly coming back, and makes you feel like it’s happening again in this moment.
Avoidance.You might find yourself wanting to avoid stimuli that remind you of the event.
Negative alterations in mood, for example, irritability and depression.
Negative alterations in arousal and reactivity, such as startle response.
Flashbacks can be triggered by anything that reminds of the event. Such reminders are often sensory, such as a smell, or a sight. One might not even consciously recognize the trigger. Flashbacks make you feel as if the thing is happening again, stealing you away from the present moment. Flashbacks are normal and to be expected. With time, and more and more integration, they will ease. There will be more and more awareness, and space around your reaction. Like, “oh, it’s THIS again” - having it and being able to see it simultaneously, with more and more of you remaining in the Here and Now.
You can think of symptoms as immediate, middle range term, and long-term. Maybe we could say that, what we want for you, is to not only have no, or few, long term symptoms, but, in the opposite, to find even greater strength, resilience, gratitude, appreciation and purpose in life than you had before. It is possible to grow stronger, kinder, and wiser from traumatic experiences.
For now, you are probably experiencing some short term symptoms. This is normal.
Symptoms affect us on three levels:
The body, our emotions, and cognition. Let’s look at these.
The Body, Emotions, and Cognition
Short term symptoms on the body level include restlessness, shaking, startle response, numbness, dizziness, tiredness, agitation, being panicky, having nausea and problems with sleeping.
Our bodies want to instinctively protect us. They want to fight, run away, or reach for help. These are great, innate impulses. With traumatization, they could not fully complete what they wanted to do. Maybe there was no time, or one's body wanted to run but "froze" instead. This is why working with the body is very useful in the aftermath of trauma. In Sensorimotor Psychotherapy, these incomplete movements are helped to “sequence through”, leading to a sense of empowerment, an “act of triumph” (Pierre Janet) in the here and now, completely honoring that that could not happen during the traumatic experience, always for good reasons. Completing these impulses now helps complete the event inside oneself, and put it in the past.
Emotionally, you might find yourself numb, irritable, having bouts of being angry, have rage, be indescribably sad, devastated, or have any other hard-to-have emotion, sometimes several of them at once. Different parts of you might hold different emotions, along with different somatic impulses. Anger, for example, often relates to the body’s impulse to protect oneself, and often through wanting to push, in order to keep the boundaries intact. Anger contains great strength, and can be the gateway to the “act of triumph”. Being aware of one’s anger and it’s impulses, and using them wisely, is key. Whatever your emotional experiences are, as much as you can, please allow yourself to greet them with openness, curiosity, and kindness for yourself. This is an ongoing practice and path in itself.
Cognitively, it might be hard to focus on anything. Due to the shock, there can be a sense of “de-realization”. Life seems surreal. You might find yourself trying to push any thought of the event away, or might find yourself thinking about it incessantly, or going back and forth between the two.
The cognitive level includes our conscious and unconscious spiritual beliefs and understandings which may be called into question, or called on for help, during traumatic experiences.
And on this (conscious or unconscious) cognitive level, we also make meaning of events.
The meaning we are making
"Meaning making" is when we draw conclusions from experiences. Usually this happens unconsciously. For example, we might “decide” that “everything is terrible”, that “nobody” can be trusted, or "I'm not loveable". This is something to watch for. You don’t want to make a meaning out of this event that is actually not true, yet creates painful and limiting consequences for your life. You want to find a truthful meaning. It could be, for example, “some things are truly terrible”, with the implication and understanding that not all things are this way. This meaning might be true for you, give your body more breath, and fosters integration. Watch for absolutes and words like "people", "everyone", "always", "never". They are not true.
Something else that can happen on the cognitive level are shame, self blame, and “should have’s”. They are different from healthy regret that we might feel in particular circumstances. If they happen to you, please see them, and see them with kindness. Don’t buy into them. One always does the best one can in overwhelming moments!
The hallmark of trauma work is what the French psychologist Pierre Janet called “integration”. The event needs to be metabolized and integrated on all these three levels: body, emotions, and cognition.
The Path: More and more integration
According to Janet, integration includes two things:
The first, he called realization: “This happened.”
The second is personalization: “It happened to me.”
Letting these truths in, slowly and a bit at a time, sets us free.
Letting these in requires staying grounded, present in our bodies, and breathing. To get there takes inner work and, often, support.
Thoughts like “It can’t be true, I must be dreaming” are natural expressions of disbelief, of shock. The head shakes “no”: “This can’t be”.
Eventually, the head will nod: “Yes, this happened. And, yes, it happened to me.”
Along the path of integration comes grief, and allowing this is a very good, and important, thing to do. Can’t do without. It comes in it’s own ways and waves, and there is no right or wrong way to grieve. If grief gets complicated and muddled up with shame or depression, it’s good to get help with it. Grief has gifts which may reveal themselves.
Some of us isolate under painful circumstances. Trying to do it all alone. Some of us, in order to avoid intrusion of traumatic memories, are trying to numb ourselves with alcohol and other drugs, maybe more and more often. Please watch for such impulses, and refrain, out of kindness for yourself, knowing that these will only lead to more pain and suffering, and that there are better ways to go about this.
It can be very helpful, might even be crucial, to reach out and connect with supportive others.
On the other hand, some people find themselves overly relying on others, having a hard time being alone. That’s okay, too, for now. We all have habitual patterns around this, and different things help at different times. In the end, the best might be a healthy, dynamic balance between regulating yourself alone (auto regulation), and regulating through contact with others (interactive regulation).
The Magic of Good Regulation
A couple more words on regulation. Regulation is a very important concept, because traumatic events are by definition dys-regulating. When you find yourself going into hyper activation (getting aggressive, panicky, speedy, raging, frantic), you need to find ways to down-regulate yourself.
You may try
Pausing and feeling your body right here and now
putting a hand on your lower belly and feeling into it
putting one hand on your heart, one on your belly
touching your arms as in a self hug, evoking a sense of containment
moving your feet against the floor
walking slowly for a few steps, breathing out with each step
making a downward movement with your palms and bending your knees as you breathe out audibly
putting a hand out with palms out, as in saying "no", or "stop"
These are some simple, yet often surprisingly effective, somatic resources that are always available to us anytime for down regulation.
When you find yourself going overly hypo, or go hypo for too long, (spacing out for long times, feeling numb, feeling dissociated, having no energy at all, feeling depressed for long), it is good to find ways to up-regulate yourself
by moving your facial muscles, making faces and sounds
putting on energizing music
washing your face with cold water
shaking your body gently all over
walking briskly on the spot for a few moments
pushing down with your feet and stretching upwards.
These somatic resources brings us back to the hugely important topic of resources, altogether.
Recognizing, Creating, and Using the Right Resources
There is a direct correlation between the ability to integrate a traumatic event, (or, for that matter, the ability to stay strong, open, and resilient during ongoing threat), and the resources that we have – and use.
Here are some kinds and categories of resources. You can ask yourself which one’s you are “good at”, so to speak, meaning they are available to you and you employ them easily, and which ones you might want to cultivate, in order to foster your perseverance, endurance, recovery, and healing.
1. Internal versus external resources.
Examples for internal resources are the awareness that sharing might be helpful, in a given moment, and the courage to reach out to a friend.
Examples for external resources are the friend and the phone.
2. Missing versus existing resources, and resources that we used and use.
There are resources we have now, as well as resources we have had during the traumatic experience. Maybe the ambulance came right away. Maybe neighbors helped you during the flood. Maybe, your faith sustained you. And how about now, in the aftermath? What resources do you have, and use? Maybe, listening to music can help you now, or journaling, or walking in nature, or your pet, or being in contact with a particular person who knows you, loves you, supports you.
3. Survival versus creative resources.
Survival resources are the ones that help us cope, but come with a price tag. Please try to not use them, at least not too much, and to not get too used to them. This is where trauma can lead to addiction.
Creative resources are the ones you are using based on choice, based on the questions: What would help me right now? What is best for me, right now? What would feel good and nourishing right now?
There are a several kinds of resources, which fit into the above categories:
Artistic expression, psychological, spiritual, relational, emotional, cognitive, physical exercise, nature, etc.
Which resources serve you most in your recovery, healing, and well-being?
Which ones might you want to use more consciously?
Maybe, with trauma comes a calling. Maybe, if we want it to, the experience(s) may lead to a deeper understanding of life’s joys and sufferings in us. To more gratitude for the good things. Maybe, and if we want it to, it may lead to more loving kindness and compassion towards ourselves and others. Even if we need to go through the fires of hatred and rage to get there. Trauma might give us new purpose in life. As Thich Nath Hanh said: “In the ash of suffering, a phoenix can be born.” Can we invite such a phoenix inside ourselves into our lives, now? What might your phoenix look like? It might reveal itself in time...
A final note: If you have a contemplative practice, such as prayer or meditation, please expect to get often taken away by body sensations, emotions, and thoughts of all kinds pertaining to the traumatic event, during your practice. Please don’t see that as a problem. Please don’t think something is wrong with you, or that you can’t meditate or pray anymore. This is simply what happens, and, actually, as you literally sit with all the inner chaos, your “Window of Tolerance” (Dan Siegel) widens. So, let it come, let it be, let it get you, say “hello” to the storm inside, over and over, coming back to the object of your practice naturally whenever you do, and finding yourself riding the winds and the waves, with more and more ease and trust in yourself and this process of integration.
With very best wishes,
Copyright Brigitta Karelis, November 2017, updated June 2022, February 2023, April 2023 ©