Perspectives on Pastoral Care

PTSD and the Holi-Daze

by L. Jan Fogleman

In many ways our nation seems to be returning to "normal" following the terrorist attacks of September 11. But we are also facing war, widespread job cuts, financial uncertainty, and scares about anthrax. These factors add up to a LOT of stress! And the factors will continue to exert a profound effect on the people of the US for many years to come. The holiday season is often stressful in the best of times, so it might be particularly difficult for people this year. Many people might experience more sadness, depression, or anxiety than usual this year. Who can forget the repeated images of the jet exploding into the World Trade Center and the collapse of the massive towers, or the wreckage of the symbol of our military strength? It is such horrible images, in the media and in our memories, that can produce post-traumatic stress reactions. Such reactions can affect all of us, and can produce depression, anxiety, or Posttraumatic Stress Disorder (PTSD) (see box below for symptoms), and make the holidays more difficult than usual.

Anxiety can wear many masks, including panic attacks, phobias (extreme and irrational fears), obsessions (preoccupations that interfere with life), extreme nervousness, or PTSD. There are four essential aspects of PTSD: a) exposure to a horrible trauma accompanied with intense feelings of fear, terror, or helplessness; b) re-experiencing symptoms; c) avoidance symptoms; d) increased arousal.

Symptoms

Depression: a) Alterations in mood and physical functioning, including prolonged sadness; b) sleeping or eating too much or too little; c) diminished interest or pleasure in regular activities; d) feeling overly nervous or lethargic; e) fatigue; f) exaggerated feelings of guilt, blame or unworthiness; g) poor concentration; or h) preoccupation with death, harm, or suicide.

Post-Traumatic Stress Disorder (PTSD) includes four essential elements:

	Experiencing or witnessing a tragedy with feelings of intense fear, helplessness, or horror. The terrorist attacks are perfect examples of the types of horrible events that can cause PTSD, as are combat, car wrecks, rape, death of a child, and domestic or public violence;
	Symptoms of re-experiencing (intrusive thoughts or memories of the event, recurrent nightmares related to the tragedy, acting or feeling like the event is happening again, or intense distress at remembering the event);
	Symptoms of avoidance (efforts to avoid thoughts, images, feelings, or conversations about the trauma, or efforts to avoid activities, places, or people that cause reminders of the trauma. Can also include inability to remember parts of the event, restricted emotions, or the feeling of a foreshortened future);
	Symptoms of increased arousal (poor sleep, irritability or anger, poor concentration, increased alertness for possible danger, or exaggerated jumpiness at loud noises.

Parents, ministers, Stephen ministers, teachers, and other care-providers should remain alert for signs of distress in people of all ages, and stand ready to take appropriate and helpful action. Children are often unable to talk about their concerns, so I have listed common symptoms for them. Children often show depression or anxiety through increased activity or lethargy, poor concentration or attention, irritability, aggression, or withdrawal. They may show increased fears, worry, or anxiety about safety. They may be more clingy, whiney irritable, or moody. They might have more physical complaints (headaches, stomachaches, pains, nausea), and might be more reactive to loud noises. Nightmares are common. Some children regress somewhat following a trauma, such as reverting to baby talk or bedwetting, although these symptoms are usually transitory given increased reassurance of security, comfort, and love. Youth might be more withdrawn and sullen or over-active and aggressive than usual. The elderly might tend toward depression while experiencing more anxiety and sleep problems.

Post-trauma reactions can be immediate or secondary, mild or intense, short- or long-term. Onset might be delayed by weeks, months, or even years. However, stress reactions might also show up in a multitude of symptoms, which people might not relate to the events of September 11. For example: increased medical problems, unemployment and financial pressures, increased mistakes or accident, increased alcohol and substance abuse, or marital and family strain. In may cases problems that were manageable before the attacks might become exaggerated or unmanageable in the face of the stressors.

So what are some suggestions for coping with the holidays in this year of increased stress?

	Be intentional about how you plan for the holidays. Examine the events and tasks of the celebration and ask if you really enjoy doing them. Are they done out of habit, free choice, an obligation?
	Decide what you can handle comfortably. Can you handle the responsibilities of a big family dinner or parties? Should you stay at home or choose a different environment?
	Don't be afraid to make changes. Consider changing the time for opening the presents or the time for dinner. Ask friends to help, or give family members different tasks to do.
	Evaluate your coping plan. Do your plans isolate you from those who love and support you best? Do your plans allow for celebration of what the holiday means to you? Sometimes we have family obligations, but actually find that "adopted family" are more supportive.
	Make your plans sensible. Make plans that are firm enough to support you, but flexible enough to leave you some freedom.
	Let your plans and limits be known. Write, phone, or e-mail family and friends to let them know of any intended changes that will affect them. Share with them how you plan to approach the holidays and how they can best help.
	Do something for others. Consider inviting a guest--someone who might otherwise be alone--to share the festivities, or make a donation to a cause you truly support. It is amazing how doing something for others helps people feel better.
	Don't be afraid to have fun. Give yourself and members of your family permission to celebrate and take pleasure in the holiday. You need not feel guilty about the losses of others.
	This might be a good time to deepen your faith and spiritual practices. Whether reading scriptures, praying, meditating, or attending religious services, explore what answers your faith tradition might offer for the problems we are facing this year.
	Get help if you need it. Family members, friends, pastors, or counselors, are ready to listen and offer support. Prepare a list of people you can call for a talk or a cry. If person A isn't available, call person B.