COVID-19 Pandemic and Trauma

I, like the rest of the world, have been watching the Covid 19 pandemic unfold with morbid fascination. At first with a sense of ‘It’s happening to other people and will not affect me’, then with an ‘it’s getting closer, but the numbers are still so low’ to finally ‘ it’s here and has become a grim reality’.

Traumatic experiences shake the foundations of our beliefs about safety and shatter our assumptions of trust. - Dr D.V. Baldwin

The surreal quality of life in limbo as we are experiencing at the moment is not be underestimated. How bizarre to be too scared to leave your home, approach others with a sense of hostility and suspicion, the new normal being excessive handwashing, sanitiser, masks and distance contact.

We are in shock. We are numb. We are trying to make sense of it all, but our brains refuse to understand. How could this possibly happen in 2020, with civilisation the most advanced it has ever been? We are angry. But mostly, we are scared.

We are experiencing trauma – commonly defined as an injury, loss of a loved one, a near loss of a loved one, witnessed a traumatic event, loss of property, a serious threat, a near-death experience, a critical stress incident or any overwhelming emotional experience.

Trauma is always sudden , unexpected and extra-ordinary

Sometimes the emotional aftershocks (or stress reactions) appear immediately after the event. Sometimes they may appear a few hours or a few days later. In some cases, weeks or months may pass before the stress reactions appear. The signs and symptoms of a stress reaction may last a few days, a few weeks of a few months. Occasionally they may last longer depending on the event and the exposure to previous incidents.

Definitions of trauma include

From the Greek word for wound, a term used freely either of physical injury caused by some direct external force or of psychological injury caused by some extreme emotional assault. - Penguin Dictionary of Psychology

An emotional shock producing a lasting, harmful effect. An unpleasant experience that causes distress or anxiety. - Oxford Advanced Learners Dictionary

Those, which include direct personal experience of an event that involves actual or threatened death, injury or a threat to the physical integrity of another person. - The American Psychiatric Association

We react differently
As every individual is unique, the reaction to a crisis will also be unique. Factors that influence the individual’s experience of trauma include gender, culture, life experience, the position of responsibility, previous exposure to trauma, where the individual fits into the circle of trauma and how closely they are affected, the duration of the trauma, who was directly and secondary involved, whether death or deaths occurred, other losses (including employment, home, material possessions, pets), feelings of guilt and the reaction of the community.

What is experienced then is mostly a normal reaction to an abnormal situation.

Normal reactions that may be experienced for the duration of the trauma

Physical reactions including shaking, trembling, headache, muscle aches, fatigue, listlessness, nausea, dizziness, fainting, chest pain (medical advice to be sought), profuse sweating, chills or feeling cold, changes in sleep patterns, changes in appetite, rapid heartbeat, increased blood pressure, rapid breathing, diarrhoea, tremors, dry lips, thirst and feeling uncoordinated.

Note: Ensure that the physical reactions due to trauma are not confused with the physical symptoms of Covid-19. Please be informed and take appropriate action when the physical symptoms of the pandemic are experienced.

Cognitive (Thinking) reactions including slowed thinking, difficulty making decisions and in problem solving, confusion, disorientation, difficulty calculating and concentrating, memory problems, difficulty naming common objects, pre-occupation with the event/crisis/situation, distressing dreams, recurring memories, suspiciousness, poor attention span and concentration, intrusive thoughts and hyper-alertness.

Emotional reactions including anxiety, grief, an overwhelming sense of loss, depression, sadness, feeling lost and alone, despair, overwhelm, feeling abandoned and isolated, worrying about others, anger, irritability, being easily startled, shock, fear, guilt, vulnerability, feeling exposed and violated, panic, mood swings, denial, numbness, emptiness, hopelessness/helplessness, self-doubt, emotionally drained and an overwhelming sense of loss of control.

Behavioural reactions include changes in ordinary behaviour, social withdrawal, restlessness, avoidance, indecisiveness, increased risk of substance abuse, change in personal habits, prolonged silences and reactions imposed by social isolation and lockdown restrictions as implemented by authorities.

All these symptoms are normal reactions to the abnormal amount of stress caused by exposure to a critical or traumatic event.

The after-effects with the greatest impact of experiencing trauma are the following

• The realisation of our own mortality.
• The overwhelming realisation of loss of control.
• The resultant spiritual/religious/moral crisis experienced because trauma changes the way we perceive the world and how we perceive ourselves.

Coping and Ultimately Recovery Strategies

• Eat healthy, well-balanced meals regularly, even if you do not feel like it. Good nutrition is very important when feeling stressed to add vitamins to boost the immune system – soup, lots of water, rooibos or camomile tea – avoid junk food, salt, sugar, caffeine, especially if you are having trouble sleeping.
  
• Avoid the use of drugs and alcohol, including prescription and OTC drugs to numb the pain. It complicates and/or delays the recovery and can add to anxiety.
• Get plenty of rest - at least 7 hours.
• Exercise regularly even if you can only manage a short walk. It can help to work off some physical stress symptoms and it may leave you feeling calmer and better able to relax; as well as energise and clear your mind.
• Structure your time and set priorities. Maintaining normal basic routines is important but you can also allow yourself to skip the extras for a while.
• Stick to your normal daily routine as much as possible.
• Don’t make any major life changes or decisions.
• Making a number of small daily decisions may reassert your sense of control.
• Don’t try to avoid or deny recurring thoughts and feelings about the situation. They are normal and will decrease over time.
• Allow yourself to feel down and negative and share your feelings with others.
• Spending time in nature is life-affirming, healing and relaxing.
• Talking to people whom you trust provides an opportunity to relive the experience in a safe environment.
• Don’t be afraid to set limits with others when you don’t feel like talking. You don’t have to discuss the incident or your feelings when you don’t want to.
• Don’t label yourself as ‘crazy’ rather remind yourself you are having normal reactions.
• Ask for help if you need it. If you are having trouble coping on your own, help is available from many online sources.
• Help anyone who shares the experience with you as much as possible by sharing feelings and checking up on how they are doing.
• Give yourself permission to feel sad and afraid and share your feelings with others.
• Keep a journal; write your way through those sleepless hours.
• Do the things you enjoy doing, within situational restrictions.
• Be patient, you won't be ‘yourself' for a while.
• Realise others who are sharing the traumatic experience are also under stress.
• Recurring thoughts, dreams and flashbacks are normal – don't try to fight them. They will decrease over time and become less painful.
• If you suffer from a chronic medical condition e.g. hypertension, diabetes, have a medical check-up with your doctor.