“I keep seeing his drooping lip and the look of fear in his face when they were putting him on the stretcher in our bedroom,” said 63-year-old Evelyn during her first psychotherapy session about the night her husband suddenly had a stroke two years before. “It was so shocking and upsetting. I don’t want to remember it, but it plays in my mind sometimes — like I’m rewatching the same horror movie.”
No one forgets moments of great danger. In fact, our memories of such crises can have a clarity and power that haunt us. In the course of their duties, family caregivers like Evelyn may be exposed to many haunting scenes — sudden medical events; bedside vigils in hospital emergency rooms and ICUs; and fearful times when their loved ones suffer calamitous falls, severe confusion or unremitting pain. More recently, some Americans have also had to deal with the devastating effects of natural disasters, such as hurricanes and fires, which disrupted and even threatened the lives of affected caregivers and care recipients.
According to the American Psychological Association’s just-released “Clinical Practice Guideline for PTSD,” overwhelming events such as these can be defined as “trauma” and may cause a host of negative psychological aftereffects that usually show up months or years after the danger has passed. Foremost among them are so-called flashbacks of the event that suddenly crash into our conscious thoughts unbidden and unwanted. These memories can make us jumpy or numb us to our own emotions. We may begin avoiding people and places that remind us of the trauma in the hopes of squelching our memories. We may never regain a sense of complete safety and then always be keyed-up and on guard against new dangers around the next bend.
This was Evelyn’s main concern. Her husband had, in fact, mostly recovered and resumed many of his previous activities. But she still doted on him anxiously during the day and, at night, stared at him while he slept to reassure herself he was not having another stroke. He thought her increased attention to him and her overall fearfulness were excessive and annoying at times.
How can caregivers like Evelyn decrease the psychological impact of trauma? Here are some ideas.
Don’t attempt to forget. Our brains tenaciously retain vivid recollections of danger for a reason: Those upsetting images lead us to be more cautious the next time we encounter similar circumstances. For example, if you opted to stay in your home during a hurricane, then traumatic memories of the ensuing flooding may persuade you to not take that chance again in the future when the forecast is for severe storms. We don’t have the power to push away these memories, but can reduce their intensity and our marked reactions to them. The best way is by openly discussing what happened with caring, supportive listeners. With each recitation of the events, we can become more used to and tolerant of the memories and images.
Remember that the past is not the present. It is one thing to recall traumatic events; it is another for those memories to make us feel we are once again plunged into immediate danger. We should pay heed to the memories but keep in mind that the crisis isn’t likely recurring in the here-and-now. For Evelyn, that meant remembering her husband’s stroke but also more accurately perceiving his state of relative wellness today. She also came to contrast how she had felt in the past — helpless and panicked — with the way she felt now — still nervous but clearly competent.
Make new meanings of the trauma. It is much better psychologically to think of oneself as a survivor than a victim. Likewise, it is preferable to think of trauma as something you’ve overcome and even benefited from than as something that has irrevocably harmed you. A truism of psychology is that it is by grappling with adversity that we learn our own resilience.
I helped Evelyn appreciate that she and her husband had not only survived stroke but had learned new lessons through the recovery process for eating better and exercising more so that they were now healthier than before. Later, she decided to volunteer on the stroke unit at the hospital where her husband had been treated. Rather than pushing away the traumatic memories, she wanted to share her experiences and lessons learned with spouses who were still in the shell-shock stage. What had been a source of fear for her had instead become a basis of wisdom for helping others.
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