HELPING OURSELVES & OTHERS
THROUGH A HEALTH CRISIS
Information, Inspiration & Hope
by Dr. Mark Lerner
Chairman, The National Center for Emotional Wellness
When we experience a serious illness or injury, there’s always a rush to address our physical needs. Healthcare professionals treat our condition with the latest technology and the most reliable medications.
But who considers our painful emotions—our anxiety, fear and feelings of aloneness? Who helps us with our overwhelming thoughts—an inability to concentrate and make decisions? Who recognizes that we are so much more than our conditions?
Unlike treating physical trauma, putting a bandage on our feelings doesn’t heal emotional wounds. When we’re sick or injured, we need practical information, inspiration and hope.
During a health crisis patients and caregivers must look beyond physical needs and also consider the "hidden trauma"—traumatic stress. While grappling with a disease or injury, people lose a sense of control. What was familiar is no longer the same. By gaining awareness and an understanding about traumatic stress reactions, people can regain a sense of control.
Beyond knowledge, it's helpful to have practical strategies that can ease our emotional pain, keep us functioning and lessen the likelihood of ongoing suffering. It's important to know 'what works' to help ourselves and others during a health crisis.
Finally, crises bring opportunities. People have the ability to harness painful emotional energy from adversity, and use that energy to propel themselves to not only survive, but thrive.
"What's happening to me?"
When we are sick or injured, we become experts on our conditions. While battling cancer, a woman describes the levels of proteins in her blood. While experiencing a lower back injury, a man discusses his lumbar spine. We become experts, because knowledge is power. Knowledge gives us the power to act, to ask relevant questions and make informed decisions. In the same way, we can become knowledgeable about traumatic stress.
Stress refers to the wear and tear on our mind and body as we adjust to changes in our environment. During a health crisis, many people experience traumatic stress—when a specific event threatens one's well-being, causes intense fear, and leads to feelings of helplessness or horror.
Traumatic stress must not be confused with Posttraumatic Stress Disorder (PTSD). PTSD, along with other psychiatric diagnoses, may apply to people who continue to experience symptoms in the future that compromise one's ability to function. By reaching people early, during times of crisis, we can prevent the acute difficulties of today from becoming the chronic problems of tomorrow.
Traumatic stress refers to our feelings, thoughts, actions, and our physical and spiritual reactions when we are exposed to, or even witness, events that overwhelm our coping and problem-solving abilities. Traumatic stress is a normal response to an abnormal event. It can affect someone who is living through a health crisis directly, and also affect those who love them, care for them and treat them.
There's no usual way in which people respond to the emotional impact of an illness or injury. Some will respond immediately, while others may experience a delayed reaction—sometimes months or even years down the road. Some people’s reactions may last for a long period of time. For others, traumatic stress reactions are short-lived.
When someone first learns of their condition, they may experience "emotional shock." They're anxious, nervous, fearful ... even panicky. Or, they may feel nothing but numbness. These reactions are very common and normal.
There may be an element of denial. One may not feel the full impact of what's happening. Denial is a mechanism that prevents people from feeling too much, too quickly.
People also experience dissociation, where things don't seem real—they may feel “spacey.” Some people describe feeling as if they’re watching themselves in a movie. Others describe their experience as surreal. People may emotionally disconnect themselves from what's happening.
Other common reactions are feelings of aloneness, emptiness, sadness, disbelief, anger, fear, resentment, helplessness, hopelessness, grief and feelings of guilt.
Of these, guilt is one of the most difficult emotions to deal with. One may now feel that they are in some way responsible for their condition. He may find himself frequently saying, “If only….”
When someone is living through a health crisis, the right half of their brain is in “fight-or-flight” mode working to keep them physically alive. Then, the left side, the verbal “thinking” part of the brain, kicks-in and they begin to process and label what’s happening. Their attention span is shorter than usual, it’s difficult to make decisions and they may be highly suggestible and vulnerable. Repetitive thoughts and recollections are common and can be overwhelming.
It's also common to have difficulty concentrating. Physical discomfort can interfere with one's thinking and negatively impact the ability to make sound decisions and choices.
Finally, it's important to know that a serious illness or injury can stir up thoughts about previous traumatic experiences. One may be thinking about prior losses or health problems, or times when there was a lack of control. In a way, the individual is not only dealing with today’s health crisis, but a history of traumatic events as well. Those who have been exposed to a number of tragedies in their lives are particularly vulnerable to traumatic stress.
Although the focus here has been on common reactions, specific reactions are as different as our unique personalities. Some people withdraw, “space-out” and become non-communicative. Others exhibit the exact opposite behavior, acting impulsively with seemingly boundless energy. Still others avoid thoughts, feelings and conversations.
One thing that’s particularly important to know is that how we respond during a crisis will become part of who we are. Not only that, but how others act will become a part of our life perceptions as well. People will always remember their family and friends' actions, as well as the actions of those who care for them.
While we can’t always control the events in our lives, we can control how we'll respond to them—how we choose to act.
Our Physical Reactions
The nature of one's illness or injury will likely dictate how their body responds. It's critical for people to keep in mind that if at any time they're having difficulty breathing, or experiencing chest pains or palpitations, they should seek immediate medical attention.
Headaches, backaches and stomachaches are common among people who are experiencing traumatic stress. Bathroom visits may be frequent. It’s also very common to experience changes in one's appetite and sleeping pattern. Disturbing dreams may occur. I often share with people, “Your mind is working overtime to try to make sense of the senseless.”
Finally, people may be hypervigilant, when they're excessively watchful and cautious. And, they may experience an increased or exaggerated startle response—making them feel jumpy when there’s a loud noise or when someone walks in on them.
Our Spiritual Reactions
Many people experience strong spiritual responses during a health crisis. They may be very angry and withdraw from worship, questioning their religious beliefs and feeling a deep and profound betrayal for having to experience their condition. Others may experience the opposite reaction, uncharacteristically turning to frequent prayer. The best person with whom to speak about this is one's spiritual leader. Physicians have the knowledge and skills to help heal the body, clergy have the knowledge and skills to help heal the spirit.
Although we can't change our circumstance, we can choose how we respond to it. While our physical condition may dictate which strategies we can use, following are 25 suggestions from the book crisisnotes, Practical Suggestions for Living Through a Challenging Experience—there are hundreds more. Many people have utilized these suggestions to help them while grappling with an illness, disease or injury.
1. Surround yourself with your family and loved ones.
2. Talk about what's happened, tell your story and allow yourself to feel.
3. Try to obtain facts about your condition.
4. Allow trusted family members or friends to help you make important decisions.
5. Spend time with people who listen more than they speak.
6. See your reactions as normal responses to an abnormal event.
7. Let yourself cry with a friend.
8. Never apologize for showing your feelings.
9. When you're feeling overwhelmed, take a slow deep breath, inhaling through your nose, hold your breath for five seconds and then exhale slowly through your mouth. Upon exhalation, think the word “relax.” Repeat this process several times.
10. Tell children the truth, at a developmentally appropriate level
11. If you find it difficult to concentrate when someone is speaking to you, focus on the specific words being said and slow down the conversation.
12. Know that it's okay not to be okay, right now.
13. Draw upon past experiences to help you to cope today.
14. When making decisions, try to keep yourself in thinking rather than feeling mode.
15. Know that you are not your body. While your body may be broken, it does not mean that you are.
16. When feeling emotionally overwhelmed, change what you are doing.
17. Recognize that what you think will affect the way you feel.
18. Avoid avoidance.
19. Know that others may say things to try to help you to feel better quickly. They may need to feel better quickly.
20. Remind yourself that you will get through this.
21. Listen to soft music.
22. Speak with a counselor or therapist.
23. Excuse yourself when people speak of others who have had the same experience.
24. Avoid people who have all the answers.
25. Realize that you are not your illness or injury.
From crisisnotes © 2012 by Mark D. Lerner, Ph.D.
During a health crisis, physical and safety needs must be the priority. Physical illness can destroy lives. However, traumatic stress can ultimately destroy many more.
Traumatic stress disables people, causes disease, precipitates mental disorders, leads to substance abuse, and destroys relationships and families. In organizations, traumatic stress can lead to communication breakdowns, a decrease in morale and group cohesiveness, workplace tension and conflict, excessive absenteeism, employee sabotage, an increase in workers’ compensation and disability claims, employee litigation, an inability to retain effective personnel, and ultimately, a decrease in productivity.
Caregivers can expand their repertoire of helping skills—beyond the physical and safety needs of people, and raise their level of care.
During a crisis, sights, sounds, smells, tastes and physical touch are indelibly etched in peoples' minds. They repeat over and over again, they “play back” in one's experience as disturbing “movies,” and they lead to uncomfortable and overwhelming thoughts. These stimuli are the precipitators of debilitating traumatic stress disorders.
The fact of the matter is that whatever we are exposed to, whatever we focus on during peak emotional experiences, will stay with use forever. However, in the same way that negative stimuli are etched in peoples' minds during a traumatic experience, so too can a positive information.
During a health crisis, we turn to physicians and other healthcare providers. Many of us turn to our spiritual leaders. Others present at a therapist’s office where an educational process begins. People tell their stories, expose themselves to their painful feelings, and learn about traumatic stress.
We shouldn’t wait for people to experience months, and sometimes years, of emotional pain and dysfunction. If what we focus on during a peak emotional experience stays with us forever, let's seize this opportunity!
One doesn't need an advanced degree in mental health in order to provide timely information and support. In fact, the best help during a health crisis is often rendered by people who take the time to listen and say the “right things” at the “right time.” However, one must know what to say and do. Traumatic experiences, by their very nature, compromise one's ability to think clearly and often leave people feeling a loss of control. By having a plan, caregivers can be prepared and responsive.
Beyond recognizing and understanding traumatic stress, those who help others must be equipped with a practical strategy.
Following are five basic elements (Acute Traumatic Stress Management. Lerner):
During a health crisis, introduce yourself and let people know your role (e.g., “My name is Angela. I’m a nurse.”). Begin to develop rapport by making an effort to understand and appreciate his situation. A simple question such as, “How are you doing?” may be used to engage the individual. Use appropriate non-verbal communication (e.g., eye contact, body turned toward him, a gentle touch, etc.). Recognize that during a challenging experience, individual reactions may present on a continuum from a totally detached, withdrawn reaction to the most intense displays of emotion (e.g., uncontrollable crying, screaming, panic, anger, fear, etc.). During a health crisis, you may find yourself working to connect with not only the patient, but also his loved ones.
Once you have established a connection, you can begin to "ground" the individual. Encourage him to “tell his story” and attempt to orient him by discussing facts regarding his illness or injury (e.g., “I understand that it’s common to have feelings of numbness”). Address the circumstances at a cognitive, or thinking level. While one should not discourage the expression of emotion, attempt to focus on the facts in the here-and-now, and help the individual to know the reality of the situation. Oftentimes, his “reality” may be seriously clouded due to the nature of the situation. Remember, a crisis can overwhelm an individual’s coping and problem-solving abilities. Assure the individual that he is now safe, if he is. He may still be “playing recordings” of aspects of his situation over and over in his mind. By reviewing facts, you may disrupt “negative cognitive rehearsal” (i.e., repetitive, potentially destructive thinking), help the individual to function, and help him to deal with the circumstances at hand.
Factual discussion will likely stimulate thoughts and feelings. This is often the time when individuals who are living through a health crisis need the most support. However, in reality, it’s also the time when many people look the other way. Many individuals feel terribly unprepared to handle others’ painful thoughts and feelings. Oftentimes, they fear that they will “open a can of worms” or “say the wrong thing.” Generally, a reasonable attempt to help others is preferable to avoidance.
Attempt to understand and respect the uniqueness of the individual—the thoughts and feelings that he’s experiencing. Strive to “give back” a sense of control that has been “taken from” him by virtue of his experience. Support him, and allow him to think and feel. When faced with a health crisis, many people will experience an overwhelming sense of aloneness and withdraw into their own world. Make a respectful effort to “enter that world,” and to help the individual to know that he is not alone and that his unique perception of his experience is important. Never attempt to talk a person out of a feeling (e.g., “Don’t be scared, you'll be fine.”). Communicate an appreciation of the other person’s experience. Attempt to understand the feelings that lie behind his words (or perhaps actions) and convey that understanding to him.
While you are attempting to support an individual by giving him the opportunity to express his thoughts and feelings, begin to normalize his reactions. This is an important component when communicating with people who may be feeling very alone. Experiencing a cascade of emotions, or perhaps a lack of emotional reactivity, may cause him to feel as if he is “losing it” and perhaps, “going crazy.” Normalizing and validating an individual’s experience will help him to know that he is a normal person trying to deal with an abnormal event.
It’s important that you do not become sympathetic and over identify with the situation with statements such as, “I know what it feels like.... When I was....” Rather, you should attempt to normalize and validate the individual’s experience with statements like, “I see this is overwhelming for you right now... facing an illness like yours would be hard for anyone to handle.”
An important component of the normalization process is to begin to educate the individual by helping him to know how people typically respond to challenging life experiences. Discuss traumatic stress—the normal response to an abnormal event.
A final strategy to help others during a health crisis is to begin to prepare the patient for what lies on the road ahead. It's is helpful to 1) review facts about the illness, disease or injury, 2) bring the person to the present, and 3) describe likely events in the future. Continue to normalize the individual's reactions.
Try to avoid using statements like “Everything is going to be okay,” or that “Everything is going to work out.” These kinds of “band-aid” statements may only serve to minimize an individual’s feelings and cause him to feel misunderstood. Instead, focus on listening and being there. It's generally not what people say that helps others the most. It's what they don't say.
The Power to Overcome!
There's a lot of talk today about helping people who are living through challenging experiences to become more resilient. Resiliency is defined as the ability to bounce back, to restore oneself. A health crisis changes us. Our goal should not be to bounce back and become the way we were if there's potential for us to grow through our experience.
We all have the power to overcome—the innate ability to harness painful emotional energy, and use that energy to propel us to cultivate a mission and live with a new sense of purpose.
It's critical to understand that what we think about will become our experience. And while we may be grappling with physical discomfort or pain, depending upon the nature of our crisis, we may be able to use this uncomfortable energy productively. We can think of ourselves as moving from victim to survivor and, ultimately, thriver.
While we’re working to cope with an illness or injury we can ask ourselves, "How would I ideally respond to my condition?" While this is a hypothetical construct, changing daily, weekly, even monthly it helps us to become goal-oriented.
A health crisis is a powerful force; a force that can disable us, or enable us, by bringing new meaning, purpose and hope into our lives.
Dr. Mark Lerner
Chairman, The National Center for Emotional Wellness
© 2015 by Dr. Mark Lerner