Some more blog for any of you who are interested in how we 'treat' the effects of our troubled 'past'. For many, the 'Past' is not 'past' it is continuous.
(Warning) The following is a recent essay I submitted for my Psychological Trauma Studies Degree, so its a bit academic and long-winded.
‘Trauma is experienced not only by the individual, but by communities and future generations.’
This essay will critically analyse the above statement with a focus on the current treatment modalities available to practitioners: taking in the milieu of the period of protracted violent conflict in Northern Ireland, colloquially known as ‘The Troubles’, and the legacy of trauma which has emerged.
In recent years the ‘Peace Process’ in Northern Ireland has been lauded as an international success story (CIPCR, 2015). With the signing of the ‘Good Friday Agreement’ (GFA), in 1998, the hope was that the violence would finally end and a new political process would flourish. It could be argued, to a certain extent, that this was achieved, but ‘subsequent years have witnessed continued sporadic violence’ and the political process has been mired in deadlock and recrimination (Bunting et al., 2013, p139; Rowan, 2015).
Another remnant of the Troubles is the long term legacy of unresolved trauma and injustice: its impact or ‘contagion’, as Lev-Wiesel (2007, p.76) puts it. A pervasive legacy of violent loss and bereavement; of serious injuries; of a perpetual fruitless quest for truth and justice; of socioeconomic deprivation; and the unresolved and unintegrated traumas of individuals, of communities, and of society in general.
This concept of complicated trauma will be the focus of this critical analysis, in how, it has affected the population of Northern Ireland; and what interventions are available in order to prevent it adversely affecting future generations. Herman (2001, p. 33) characterises trauma as an affliction of the powerless in which the victim is rendered helpless by an overwhelming force: fundamentally altering the ‘systems of care that give people a sense of control, connection and meaning’. Many of the victims were subjected to this overwhelming force of bombs and bullets which ripped families and bodies apart. They lost trust in society because society could not protect them nor provide justice. This is outlined by Kirshner (1994, in Eagle and Kaminer, 2013, p.94) who posits that any damage to the social order can produce ‘numbing, withdrawal, alienation, and disillusionment’. They had no control as the threat was ‘largely faceless and unpredictable, yet pervasive and substantive’; powerlessness and helplessness were prevalent features in Northern Ireland (Eagle and Kaminer, 2013, p.89). For many the traumatic event was random and unexpected; finding meaning was problematic.
The violence of the shootings, the bombings and the sectarian strife were common recurrences for certain sections of the population who experienced the conflict with more intensity, and with a more prolonged frequency than others, (Fay et al., Morrissey, Smyth, & Wong, 1999). Smyth, Morrissey and Hamilton (2004, in Ferry et al., 2010) reveal that ‘40% of the deaths from political violence [occurred] in [Belfast], and 75% of these deaths [occurred] in North and West Belfast’.
Ferry et al. (2010) highlight the aftermath of the conflict by claiming that Northern Ireland has the highest levels of Post-Traumatic Stress Disorder (PTSD) in the world with a 61% adult population lifetime exposure to a traumatic event. PTSD symptoms include: re-experiencing of the event through intrusive memories; avoidance and numbing; and hyper-vigilance. The presence of PTSD may bring with it a range of comorbidities such as mood, anxiety or substance abuse disorders according to Shalev and Yehuda (1998).
Due to the nature of the conflict during the Troubles there was an inherent fear of the other (which fed into the poison of prejudice and sectarianism); a fear of entering certain areas; a fear of revealing personal information (which manifested in anxiety, especially among security force families): fears which may or may not have been based in reality (McKenna, 2015; Stewart and Thomson, 2005; Black, 2004). Van der Kolk and McFarlane (1996, p.6) assert that, ‘[...] the core issue of trauma is reality’. However, for many, a ‘real’ fear and anxiety still exists in this society. It is not yet a society that has fully emerged from conflict.
Healey (2004) argues that the term ‘post’ traumatic minimises the effect that such continuous violence has had on individuals and communities: as ‘post’ implies a discrete event, located in the past. Healey (2004, p.177) describes Northern Ireland as a ‘pre-post-conflict society’. Straker (1987, in Stewart and Thomson, 2005, p.105) conceptualise a phenomenon of ‘continuous traumatic stress syndrome’; while Eagle and Kaminer (2013, p.85) have expanded upon this with the concept of ‘continuous traumatic stress’ (CTS).
The nature of the violence in Northern Ireland markedly changed after the GFA: from that of daily bombings and shootings to paramilitary and sectarian intimidation in the form of punishment beatings, expulsions, and the targeting of family homes with petrol bombs. Dissident republican have continued to attack the police and State apparatus (U.tv, 2015). Eagle and Kaminer (2013, p.90) posit that the symptoms of CTS may be consistent with PTSD but they occur ‘in a context of realistic ongoing threat and therefore cannot be characterized as a maladaptive “false alarm” response to a past event’.This focus on CTS does not, however, take away the severity of how a single event can affect individuals who previously had minimal or no trauma exposure at all. Summerfield (2000, p. 232) postulates that, ‘[t]here is no such thing as a universal response to highly stressful events’. Vogler (2003, p. 10) affirms that the ‘traumatic experience of one person is an interpretive construct that may not be shared in another, even in identical situations’.
Nevertheless, it is this pervasive everyday violence still that plagues many communities in Northern Ireland. It is with this severity, frequency, continuity and proximity to traumatic events in mind that one can envisage how, not only individuals, could be adversely affected, but also how this could ripple out into communities, and even into future generations. It could be argued that certain sections of the NI population displayed characteristics of collective trauma, in that, hypervigilance and avoidance were common features of daily life responses: primarily utilised as ‘protective’ mechanisms (Stewart and Thomson, 2005, p.105). Eagle and Kaminer (2013) expand on this observation by affirming that people experiencing CTS are preoccupied with thoughts about potential future traumatic events rather than on the thoughts of a previous unresolved event.
The concept of transgenerational trauma (TGT) has been put forward as a way of explaining how trauma can be experienced by future generations. There are a number of theoretical models posited in the TGT literature such as: psychodynamic; sociocultural; family systems; and biological (Kellerman, 2001). Within these models lie transmission mechanisms: with silence considered as being most pervasive.
McKenna (2015) postulates that communication within families has become a determinant of trauma transmission: echoing McNally (2014, p.32) who asserts that traumatic experiences could lead to the development of ‘unhealthy methods of communication’ within the family: ranging ‘from silence to intrusive attempts to discuss the events and imposing their interpretations [onto their children]’.
Danieli (1985, p.298) pinpoints this ‘Conspiracy of Silence’ as a major factor in the transmission of trauma. An insidious silence within individuals, within families’ within communities: and within the NI statutory sector - which led to a vacuum in services that could have potentially addressed trauma (Healey, 2004). Silence hinders attempts to employ psychotherapy as a model of treatment. If the trauma is severe and continuous there may be no words, no narrative based in reality for the client to integrate. Psychotherapy requires a conversation, one that is ‘co-created, one that enables meaning and understanding to develop, a process [where] a coherent narrative can develop: [where] the hearing and witnessing [is important]; [a virtual impossibility in] a context of silence’ (Healey, 2004, p.168).
The National Institute for Health and Clinical Excellence (2005) guidelines recommend a range of psychotherapeutic treatment models to deal with the pathological effects of PTSD, for example, Trauma Focused Cognitive Behaviour Therapy (TF-CBT). Most conceptualisations and interventions aimed at treating traumatic stress assume that the experience is firmly rooted in the past yet, as discussed above, for many in Northern Ireland the traumatic stressors are in the present, and potentially in the future. Eagle and Kaminer (2013, p.92) emphasise that a central facet of CBT interventions is ‘exposure’ to the previous event in an assumed place of safety with the intention of reducing ‘anxiety associated with [...] the past experience, [again assuming] that the danger is now past’. This essay will now expand upon a selection of models that may be more suited to the ongoing effects of CTS: systemic family therapy; psycho-education; and therapeutic witnessing.
Healey (2004) who worked as a therapist in The Family Trauma Centre, in Belfast, promotes the value of systemic family therapy: a model which takes into account not just the trauma within an individual but one that is culturally sensitive; which pays attention to the whole system within which people exist i.e. their families; their communities; and the socio-political context. With this in mind, Healey (2004, p.168) attempted to help the parents to find ways to ‘break the silence’ in the hope that this would aid communication and interaction within the family; and also between the therapist and the family. Healey (2004, p.171) described families ‘at war’ with themselves that needed their own ‘peace agreement’, reflecting the context of the ongoing peace process outside the therapy room at that time.
Healey (2004) posits that psycho-educational material can be useful as a client can develop an understanding of what is happening and can learn some coping mechanisms. This is in line with Feltham (2000, p. 10) who asserts that psycho-educational guidance can ‘enhance cognitive, behavioural and interpersonal functioning’ by teaching personal skills such as ‘parent effectiveness training, relapse prevention programmes, [and] stress inoculation training’. However, Healey (2004, p.178) concedes that it is ‘difficult to provide effective treatment for continuous trauma by virtue of [it being continuous]; real honesty is required; and the language used must reflect reality and be meaningful. Straker and Moosa (1994, p.457) highlight these difficulties by asserting: that as the trauma is continuous, ‘the survivors are at great risk of being retraumatized’. Healey (2004) claims to have witnessed retraumatisation between sessions.
Therapeutic witnessing is another model promoted by Healey (2004, p.180), from her work in the Family Trauma Centre, as being beneficial to ‘families subjected to continuous trauma’: in that, it is ‘important [to] bear witness to the “story lived”’. Blackwell (1997, p.87) highlights the importance of the therapist in this dyad: as the therapist bears witness ‘to who the client is and what their experience has been [by providing] a recognition of what has happened, how the client’s life has changed and how they come to feel about their lives and themselves’. Janoff-Bulman (1992, in Eagle and Kaminer, 2013) asserts that trauma shatters the core beliefs, which form our foundations; of what we inherently assume about the world i.e. that it is benign and meaningful. Blackwell (1997, p.87) posits that recognition helps the client to ‘piece together the shattered parts of [their] subjective continuity and recover [their] sense of integrity as a whole person’; by integrating the ‘past with the present [and the] possibility of the future’. Furthermore Blackwell (1997, p.87) claims that bearing witness can ‘change the shape of the world in which we all live’ by recognising how organised violence can disorganise and fragment whole communities, cultures, belief systems, and ideas.
Eagle and Kaminer (2013) emphasise that they are not seeking to propose that CTS becomes a new diagnostic category which may colonise a group of individuals as pathological or disordered. Instead they view CTS from a phenomenological perspective: to be addressed by systemic political and social interventions. They posit that people who are embroiled in a climate of ongoing political violence and oppression are wise to temporarily employ protective coping mechanisms such as hypervigilance and avoidance in order to survive: citing the work of Martin-Baro (1989); and Samayoa (1987) which points to the need to cling to ‘prejudices’; ‘absolutism’; ‘rigidity’, [and] ‘paranoid defensiveness’. Lahad and Leykin (2010, p.695) emphasise that constant threat causes permanent arousal leaving such populations with ‘[no] time for respite and are thus constantly governed by [fright or flight responses], or employ avoidance [techniques to dampen these reactions]’. Nonetheless, Kesebir et al. (2011, in Eagle and Kaminer, 2013, p.96) warn that what may be ‘good for the individual’s control of anxiety […] may sometimes have harmful consequences for society’.
Eagle and Kaminer (2013, p.96) offer a context-driven ‘idea that trauma-related responses may remit, consequent upon removal from a threatening environment’. Until the ongoing threat is lifted it may be difficult for conventional treatment models, as recommended by the NICE guidelines, to be efficacious.
In conclusion, this essay has provided a critical analysis of how certain treatment modalities could be utilised, in the context of the impact of the Troubles in Northern Ireland, and the ripple effects of violence and threat that remain to this day: upon which the concept of Continuous Traumatic Stress was explored. The effect of CTS on society was viewed as being harmful until ongoing threat was removed through political and social intervention. The transmission of trauma through a culture of silence was given as a possible mechanism. It is within this context that one can claim that ‘trauma is experienced not only by the individual, but by communities and future generations.’
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