After the war
I had my first experience as a psychologist with PTSD at a psychiatric clinic in Trondheim, Norway at the end of the 1960’s. We had men admitted with anxiety, depression, alcoholism, sleeping problems and related ailments. The one thing they had in common was that they had participated in World War II in various ways.
They had fought in the resistance movement, been tortured or imprisoned in concentration camps, participated in active duty or worked in the Norwegian merchant fleet. I was amazed at how these men had managed to live with these traumatic experiences for nearly 20 years before the symptoms manifested themselves in full.
Written by: Arnfinn T. Berg (7.october 1942 – 19. december 2002)
Clinical Psychologist, Private Practice.
Revised 28. January 2024, by Knut A Braa
Heroes of war
At the time there existed very little systematic knowledge about or understanding of the treatment of reactions to trauma. Neither were there any effective treatment methods for the long-term, negative effects of trauma. Many countries had participated in the two world wars, but it was during the U.S.A.’s war in Vietnam that focus was gradually directed toward long-term psychological reactions to traumatic events.
All these men who were admitted to the hospitals were heroes after the war, and their actions were something to be proud of. Others admired them and ascribed almost supernatural powers to them.
Therefore, it was even more difficult for them to admit to others, not to mention to themselves, that they struggled with inner symptoms such as fear and depression, which our culture defines as weakness.
What does Trauma mean?
When we talk about trauma, we’re referring to experiences that hurt us deeply, not just physically, but emotionally too. It’s like when something happens that leaves a mark on our hearts and minds.
What’s important to know is that trauma is different for everyone. What might seem okay for one person could be really tough for another. So, it’s not fair to judge someone else’s experience based on our own feelings.
Sometimes, people might say things that make it seem like they don’t understand how hard it was for us. They might say, “It wasn’t that bad,” or “You should’ve handled it better.” But the truth is, they might not get how much it hurt because they’re not in our shoes. And that’s okay.
We just need to remember that our feelings are valid, no matter what anyone else thinks.
What is PTSD and what defines it?
The term PTSD (Post-Traumatic Stress Disorder) has become widely recognized in medical circles and beyond. It refers to a condition triggered by exposure to traumatic events, resulting in a range of symptoms that significantly impact an individual’s life.
Here’s a simplified breakdown of PTSD symptoms:
A: Experiencing Trauma:
– Direct exposure, witnessing, or confronting situations involving actual or threatened injury or loss of life.
– Reacting with intense fear or helplessness during the traumatic event.
B: Re-experiencing the Trauma:
– Distressing memories resurface, often in vivid mental images, sounds, or sensations.
– Recurrent nightmares related to the traumatic event.
– Feeling as if the trauma is recurring, sometimes with hallucinations or flashbacks.
– Avoidance of triggers or reminders associated with the trauma, causing intense discomfort.
– Physical reactions to reminders, both external and internal.
C: Avoidance and Numbing:
– Avoidance of thoughts, conversations, or situations related to the trauma.
– Inability to recall key aspects of the traumatic event.
– Loss of interest in previously enjoyable activities.
– Feeling disconnected from others or estranged from oneself.
– Diminished emotional range, including difficulty feeling positive emotions.
D: Hyperarousal and Reactivity:
– Persistent difficulty sleeping or experiencing disturbed sleep patterns.
– Irritability, anger outbursts, or emotional volatility.
– Trouble concentrating or staying focused.
– Heightened state of alertness or hypervigilance.
– Experiencing extreme physical reactions like sweating.
E: Duration:
– Symptoms persist for more than three months.
The list above is simplified, and in reality there are innumerable variations of these and other combinations of symptoms and afflictions. In reality, reactions like these can last years and in many cases become more pronounced over time. In some cases, the reactions are so problematic that they affect the person’s work, enjoyment of life and relationships with other people.
Many try to live with it by withdrawing from participation in normal life. Others try to alleviate the symptoms with alcohol or other drugs to reduce pain or provide escape. Still others find no other way to relieve the pain than to consider suicide, and some make the drastic decision to end their own lives.
What is Stress?
Dr. Hans Selye, a pioneering Canadian researcher, was among the first to explore the concept of stress. He meticulously outlined the stages of stress, detailing the profound physical and mental changes that occur as stress manifests and evolves. Selye made a critical distinction between what he termed “good stress” or EUSTRESS, and “bad stress” or DISTRESS.
EUSTRESS, according to Selye, is the positive stress we experience when we are deeply engaged in something, feel excited, or work diligently towards a goal. This form of stress activates our body’s natural responses, such as an increase in adrenaline production, leaving us feeling invigorated and empowered. Once the situation subsides, our bodies return to a state of calm, and we often remember the experience as a positive one.
Bad stress
On the other hand, DISTRESS, or bad stress, triggers negative emotions like fear and anxiety. This type of stress can overwhelm us, leaving us feeling threatened and hopeless. While Selye originally differentiated between these two forms of stress, modern usage tends to focus more on the negative aspects of stress.
Stress, fundamentally, is a physiological reaction to unexpected or threatening situations, initiating what Selye referred to as the “alarm stage.” In its most extreme form, stress can lead to fatigue, affecting both our physical and mental well-being.
The events that precipitate stress are often referred to as traumas and can range from singular occurrences like accidents or assaults to ongoing, distressing situations such as abusive relationships or prolonged exposure to violence. Each person’s experience of stress and trauma is unique, shaped by individual factors and coping mechanisms.
It’s essential to recognize the diversity in how individuals respond to and manage stressful situations. While some may find resilience and coping strategies, others may struggle significantly. Understanding these differences is crucial in providing effective support and intervention for those grappling with the effects of stress and trauma.
Traumatic Reaction I
It’s crucial to understand that reacting to trauma is a natural and necessary response for survival. In fact, not reacting can be abnormal and potentially fatal. To grasp this phenomenon fully, we need to consider the evolution of humanity over thousands, even millions of years.
Every living creature possesses a survival instinct, which dictates fundamental mechanisms for reacting to threats. None of us, whether animal or plant, could have survived without developing these survival strategies.
Survival mechanisms
These mechanisms are deeply ingrained within us, residing in our brains. They govern our heart rate, blood flow, breathing, internal organs, senses, and various hormones. This instinctual response operates automatically, almost as if nature doesn’t trust us to make decisions in threatening situations. Instead, it takes control and guides us to safety without seeking our consent. And for that, we should be grateful.
These survival mechanisms are located in the primitive part of our brain, often referred to as the “reptile brain” due to its similarity to the brains of reptiles.
Above this primal part lies the “feeling brain,” which we share with other mammals that give birth to live offspring. Only humans have further evolved to develop the cortex, responsible for our higher-order thinking.
The cortex tirelessly works to make sense of our surroundings and experiences, providing us with an awareness of our existence, capabilities, and limitations. However, it cannot fully comprehend the actions of the more instinctual parts of the brain.
Primal brain kicks into gear
When the primal brain kicks into gear, flooding our system with adrenaline to prepare us for quick and decisive action, we become aware of this physiological response. We might label it as distress, tension, or anxiety. Our attempts to rationalize these feelings often fall short, leading to a cycle of increased worry and heightened physiological responses.
This self-reinforcing mechanism, simplified as the fear of fear, demonstrates how our instinctual reactions can escalate in the absence of complete understanding. Recognizing and addressing these responses is crucial in managing the aftermath of trauma and promoting healing and resilience.
Traumatic Reaction II
Understanding the Instinctual Response to Trauma
In moments of crisis, our bodies instinctively kick into survival mode, activating primal mechanisms that have evolved over millennia. These responses, deeply ingrained in our biology, typically manifest in two primary ways: fight or flight.
Fight or Defend
When faced with danger, our organism mobilizes for confrontation. We’re primed to utilize aggression, ready to defend ourselves or others against the threat. This instinctual reaction is our body’s way of preparing for combat, marshaling our resources for a potential showdown.
Flight or Escape
Alternatively, our survival instinct may prompt us to flee to safety. In this scenario, our bodies gear up for rapid escape, poised to jump, climb, or run as swiftly as possible. Again, no detailed report is sent “upward” through our cognitive system. Instead, our cortex registers the disturbance, but understanding eludes us, leading to feelings of worry and confusion.
The Role of Adrenaline
This heightened state triggers a surge of adrenaline, flooding our system with energy and power. It’s akin to giving our metaphorical gas pedal a firm push, enhancing our readiness to confront or evade danger. While this response served our prehistoric ancestors well in the jungle, in our modern world, it can sometimes prove more of a hindrance than a help.
The Reptile Party
To illustrate this concept, consider the effects of alcohol on our brain. Alcohol progressively dampens our higher cognitive functions, starting with the cortex. As inhibitions fade, primal emotions like happiness, anger, and aggression are unleashed. Further imbibing loosens the grip of our “feeling brain,” allowing our most primitive instincts to take control. This regression can lead to confrontations, stubbornness, and impaired reasoning—a phenomenon aptly dubbed the “reptile party.”
**Navigating the Aftermath**
Understanding these physiological responses is crucial in comprehending the impact of traumatic experiences. When our organism’s preparedness escalates dramatically, it can profoundly influence our thoughts, emotions, and behaviors during and after a traumatic event. By shedding light on these instinctual reactions, we can begin to unravel the complexities of trauma and pave the way for healing and resilience.
Traumatic Reaction III
Understanding the Physical Response to Trauma
When faced with a traumatic threat, our bodies undergo significant changes as our survival mechanisms kick into high gear. Here’s a rundown of some key physiological responses:
- **Adrenaline Surge**: Adrenaline production skyrockets, providing us with a burst of energy to deal with the impending danger.
- **Elimination of Weight**: We may experience the need to urinate or have bowel movements, a common response to distressing situations.
- **Increased Heart Rate**: Our heart beats harder and faster, pumping vital nutrients and oxygen to our muscles.
- **Respiratory Changes**: We may hold our breath or hyperventilate, resulting in short, rapid breaths.
- **Sweating**: Cold sweats may occur as our body temperature rises in response to stress.
- **Changes in Vision**: Pupils dilate, and we rely more on peripheral vision, sometimes leading to tunnel vision or color blindness.
- **Heightened Hearing**: Our senses become more acute as we scan for unfamiliar sounds that may signal danger, often disrupting sleep patterns.
- **Decreased Mucus Production**: Our bodies reduce mucus production in the mouth and stomach, as the need for food consumption diminishes in times of danger.
- **Muscle Tension**: We tense our diaphragm, leading to sensations of tightness or tingling in the arms and chest.
- **Numbing of Senses**: Some senses, like hearing and touch, may be temporarily suppressed, making us less aware of pain or injuries.
- **Skin Changes**: Blood is diverted from the skin’s surface to essential organs, resulting in cold, clammy skin and possible numbness or tingling sensations.
- **Cognitive Responses**: Our brain goes into overdrive, conjuring up worst-case scenarios and flooding the cortex with alarming information.
- **Fight, Flight, or Freeze**
In response to imminent danger, our bodies instinctively prepare to fight, flee, or sometimes, freeze. Freezing, or immobilization, may seem counterintuitive, but it’s a survival mechanism inherited from our prehistoric ancestors. Similar behaviors can be observed in certain animals as well, such as playing dead or acting unpredictably to confuse predators.
- **The Role of Memory**
Throughout the trauma, our primal brain meticulously records every detail—where we were, what we saw, how it smelled, and more. This information is stored for future reference, shaping our responses to similar threats down the line. However, this process occurs automatically, outside our conscious control.
- **Impact on Daily Life**
While this finely tuned warning system has undoubtedly helped us survive, it can pose challenges in modern society. Our heightened state of preparedness isn’t easily switched off, leading to ongoing distress and anxiety. Some individuals may turn to alcohol in an attempt to dampen these responses temporarily.
In essence, these physiological reactions are entirely normal, but they can be frightening when experienced for the first time. Understanding them can help demystify the process and pave the way for effective coping strategies and recovery.
Traumatic Reaction IV
Coping Mechanisms During Trauma: Dissociation
Another survival strategy that may arise during trauma is dissociation, a phenomenon where individuals feel disconnected from themselves, as if observing the events from outside their own bodies.
During dissociation, the person may convince themselves that what is happening isn’t real or isn’t happening to them. This detachment extends beyond fear and pain, numbing all emotions and sensations. They may describe feeling like the “living dead,” devoid of any sensory or emotional experience.
For some, dissociation becomes a means of enduring the trauma, shutting out everything to preserve a sense of survival. However, this state can persist long after the traumatic event has ended, leaving individuals feeling detached and emotionally flat. This detachment can impact their relationships and overall quality of life.
In some cases, individuals may lose all sense of consequence, feeling as if nothing matters anymore. Others may seek out extreme experiences to reignite a sense of being alive.
Personality Changes and Their Impact
Dissociation is just one example of the personality changes that can occur following trauma. Loved ones may notice shifts in the individual’s character, interests, values, and thought patterns. The person affected may either deny these changes or acknowledge them while concealing the underlying reasons.
It’s important to note that individuals who have endured prolonged mistreatment, such as women in abusive relationships, may face criticism for changes in their behavior. This criticism often fails to recognize the trauma they’ve experienced, attributing the shifts solely to their actions rather than the circumstances they’ve endured.
Understanding these complex responses to trauma can help provide support and empathy to those who have undergone such experiences, fostering a more compassionate and understanding environment for healing and recovery.
Traumatic Reaction V
As described earlier, the brain notices and registers everything that happens during the traumatic event. But when the event is extreme, safety and survival are prioritized.
The first message is to resolve the situation so that the situation is safe or that the person has found safety. One does not have time to evaluate, reflect upon or process all the data that one perceives. Everything is quick saved in a “temporary file,” to use a term from the IT world. Survival is the first, most important and only message in such a situation.
Post-Reaction I
Processing Trauma: Immediate and Ongoing Support
Only once the danger has passed and the individual is safe can they begin to process and reflect on what occurred. This reaction often occurs later and can be surprising in its intensity. Individuals may experience trembling, crying, anger, difficulty sleeping, and distressing nightmares related to the traumatic event.
Unfortunately, many people endure these struggles alone, feeling isolated and miserable. While crisis support may have been offered immediately following the event, individuals often decline assistance, believing they can cope on their own once the immediate threat has passed.
The reality, however, is that processing trauma requires time, support, and understanding. For those who cannot return home and must continue to live in threatening or dangerous situations, the challenges can be even more profound. Norwegian merchant sailors during wartime, for instance, faced ongoing threats for years, exacerbating their trauma.
Immediate Treatment Measures
In recent years, there has been significant progress in crisis intervention techniques. Two key principles guide this work:
1. Detailed Information: Individuals are provided with thorough information about the event they’ve experienced. This includes detailed explanations and opportunities for questions and discussion. By understanding the context of their experience—such as the source of loud noises or the origin of screams—individuals can begin to make sense of their own reactions.
2. Emotional Expression and Support: Crisis support emphasizes the importance of allowing individuals to express and process their emotions. This can involve talking about their experiences and feelings, as well as receiving validation and support from others who have undergone similar traumas. This validation helps individuals recognize that their reactions are normal and understandable given the circumstances.
3. Long-Term Healing
For significant traumas, ongoing crisis support over an extended period is often necessary to regain emotional equilibrium, integrate the event into their past, and move forward with their lives. By providing a supportive environment for processing emotions and experiences, individuals can gradually find a sense of closure and resilience in the face of adversity.
Post-Reaction II
Understanding Loss and Trauma: Psychological Impact
Traumatic experiences often lead to various forms of loss, extending beyond physical or material aspects to include psychological losses. Individuals may:
– Feel a loss of control over their own lives, thoughts, and emotions.
– Lose trust in people, faith in a higher power, or belief in rationality and justice.
– Experience a diminished sense of strength or invulnerability.
– Lose hope for the future or belief in their own autonomy and worth.
– Question their abilities, talents, and skills, leading to a loss of self-esteem and confidence.
These losses can trigger feelings of mourning, sadness, and despair, which, if left unacknowledged and unprocessed, may evolve into chronic psychological issues such as depression and resignation. Professional intervention is often necessary to address and mitigate these reactions over time.
Processing Trauma: The Role of Time and Support
Nature has endowed us with mechanisms to cope with trauma, injury, and loss. Our minds require rest, reflection, and time to process experiences, often through dreams during sleep. However, intense trauma can overwhelm us, leading to suppression or apparent forgetfulness of these experiences. Individuals who have endured traumatic childhoods, for instance, may have fragmented or limited memories of their past.
Subsequently, the brain attempts to reconcile these experiences, prompting individuals to remember and process unresolved feelings. This can manifest through various means, including dreams and physical symptoms such as disorders like anorexia nervosa or fibromyalgia. However, some memories may be too intense for dreams, resulting in debilitating nightmares that disturb sleep and exacerbate stress levels.
Negative Cycles and Coping Mechanisms
Unfortunately, disturbed sleep can become a source of additional distress, leading individuals to fear sleep and resort to substances like alcohol or sleeping pills. While these substances may offer temporary relief, they inhibit dream activity, perpetuating negative cycles of avoidance and suppression.
It’s crucial to recognize these patterns and seek professional support to break free from these cycles and initiate a healing process that addresses both the psychological and physical manifestations of trauma.
Treatment of PTSD
Much can be done, even though a good deal of time has elapsed after the trauma and the symptoms are chronic and all-encompassing. Extensive research on this topic has been carried out in the past few years. This knowledge has been passed on to professionals, and expertise in treatment has been developed.
Several different methods have been developed that seem to have a positive effect on this disorder. The methods are different and must be adapted to the individual and the situation, but common to them all are that the treatment addresses and helps process much of what has been described above.
It would be impossible to describe the various treatment methods in detail here, but if you, the reader, recognize yourself in some of what has been described, the first step is to acknowledge it to yourself, then contact someone who can help you or give you information about someone who can help.
Conclusion
The Emotional Toll of Service: A Soldier’s Journey
In “The Long Way Home” by Knut Braa, readers are taken on a deeply personal journey through the harrowing experiences of a 19-year-old soldier in Lebanon. The narrative delves into the traumatic aftermath of war, revealing the profound impact it has left on the author’s life. While some may find parallels with their own struggles, each individual’s response to trauma is unique, shaped by their own experiences and resilience.
The author’s account sheds light on the sacrifices made by countless men and women who, in their prime years, felt compelled to serve their country. These individuals were once vibrant and robust, both physically and emotionally, with no lingering shadows from their past. They underwent rigorous training, preparing them for the challenges ahead, but nothing could have prepared them for the magnitude of what they would face in the line of duty.
It’s likely that many across our nation now bear unseen wounds, scars that refuse to fade with time. These are the unsung heroes who bravely served in conflict zones like Gaza, Congo, Lebanon, Bosnia, Kosovo, and Afghanistan. Yet, upon their return home, they found themselves grappling with the weight of their experiences, often without the support they desperately needed.
As we look to the future, it’s conceivable that more will follow in their footsteps, answering the call to serve in distant lands. But we cannot forget those who have already borne the burden of war, those who still carry its heavy toll. It’s time to acknowledge their pain and provide the assistance they deserve, for their sacrifices should never be forgotten or overlooked.
Afterwards
Honoring Arnfinn T Berg: A Tribute to a Life Saver
In the winter of 2002, we lost a dear friend and a true life saver, Arnfinn T Berg, in a tragic traffic accident. Arnfinn was not just an ordinary psychologist; he was an extraordinary soul who touched the lives of many, including my own.
His unwavering dedication to helping others knew no bounds. With compassion in his heart and wisdom in his words, Arnfinn guided countless individuals through their darkest moments, offering solace and support when they needed it most. I was fortunate enough to be one of those individuals who benefited from his guidance and kindness.
As I reflect on the impact Arnfinn had on my life, I am filled with gratitude for the time we shared and the lessons he imparted. He taught me the importance of empathy, resilience, and the power of human connection. His legacy lives on in the lives he touched and the hearts he healed.
In the upcoming blog posts, I will delve deeper into the profound impact of Arnfinn’s work and share more about the lessons he taught me. Until then, I invite you to explore these short posts and join me in honoring the memory of a remarkable individual who made a difference in the lives of so many.
This article was written for me in my book The Long Way Home. I will focus on this topic in more blogposts to come.
See also blog for more post on this topic.