Jun 27, 2021
Acute vs Chronic Trauma: We Treat them So Differently with Adverse Effects as a Result
Acute Trauma
The collapse of the Surfside condominium is horrifying on many levels. First, lives were lost, although we don’t know how many. Families are in a state of shock, struggling to understand what has happened to their loved ones and how to find an explanation for the unspeakable. Second, homes were lost along with those irreplaceable items we keep and treasure. Third, those in nearby buildings are worried about the collapse of their own residences. Fourth, those living across the globe in apartment structures are fearful that their homes are at risk too. And, lastly, for those of us who witness the fall of the Twin Towers or the Oklahoma City Federal building can’t help but notice the similarities in how these collapses looked, with buildings just imploding.
On news media, we are learning about those saved in Surfside and those who are missing. Photos and messages have been placed on a fence at the disaster site and people are stopping by to post images, leave flowers, pray and cry. And, just stare. Media have conducted interviews of the families of those missing, sharing more about the lives of their loved ones — details about all that their parents or children or relatives brought to the world. Chilling. Sad. Deeply moving. Hard.
Chronic Trauma
Here is the contrast I cannot help but notice — and it has something to do with the difference between acute and chronic disasters, the differences between acute and chronic trauma. The Pandemic has been, by any measure, chronic trauma (although felt acutely in individual instances). The Pandemic and all of its direct and collateral effects have been with us for more than 18 months, and these effects will be with us in very real ways moving forward for the next 18th months if not way longer as we try to reestablish ourselves at home, at work, in our social lives, in our community. And, the Pandemic’s impact is vast — touching virtually all corners of the globe.
In the US alone, millions of people have been ill (whether they stayed at home or went into a hospital). Workers are exhausted, especially those on the front line (broadly defined). And, 600,000 lives have been lost. Depending on which data one references, between 1 in 2 or 1 in 3 or 1 in 5 individuals have known someone who died from COVID-19.
We know too that the traditional rituals that accompany death (religious, cultural, social) have been truncated. We have been masked and social distanced. We have buried or cremated the dead with regularity but without the regular recognition. Few funerals. Few gatherings. Few burials. Few get-togethers to commemorate.
Here’s my point: while local TV stations feature some of those who have died on the news and the NY Times has shown objects of importance to many who have not survived and local communities have done different sorts of memorials, we have had a harder time as a nation memorializing, dealing with and chronicling chronic trauma and the lives touched.
I have been struck by how the media has covered mainly the medical aspects of COVID. We have doctors and nurses and healthcare workers on the news. Dr. Fauci has appeared more times than we (or he) can count. Physical health matters. Knowledge matters. Information matters. Updates matter.
Yes, President elect Biden did light candles (a representative number of 400 lights to mark 400,000 deaths) on the eve of his inauguration, and he had a moment of silence when we reached the total of 500,000 with a candle lighting ceremony. We’re now at 600,000.
That’s an unimaginable number.
The Personal Stories
When the NYTimes covered the Fall of the Twin Towers in the days and months following 9/11, they printed Portraits in Grief. Every single person who died in NY, PA and at the Pentagon were described. The “Portraits” went on and on and on. And they shared personal information about the person who died and his/her survivors. They often had a personal anecdote too. I have written about these Portraits and the impact they had on me; I focused mainly on the survivors.
See: https://digitalcommons.nyls.edu/cgi/viewcontent.cgi?article=1037&context=fac_articles_chapters
I miss those stories in the context of the Pandemic. The “Portraits” were, for me, a way of identifying with the magnitude of the event I witnessed first hand. They stories humanized a horrific terrorist event. It gave me an anchor, a way of marking the events and remembering and feeling.
The the stories of the missing in the Surfside catastrophe will not be missing for long. They are already emerging. We can already see a difference. We have heard voices from so many families; we have seen images of memorials. In the context of the Pandemic, we mostly saw images of hospitals in chaos and bodies loaded into freezer trucks and nurses and doctors sharing that the deceased breathed their last breath before them, with family on Facetime when possible.
The Why Question
This all got me thinking of the “why” question. Why are we so much better at dealing with acute disasters than chronic ones? What distinguishes them and why are the personal stories and the memorials (grand and smaller) less central in chronic trauma?
There are, of course, no simple answers. But, several reasons pop to mind.
First, we are used to acute disasters — including school shootings. We have had experience with them. We have disaster teams that know how to deal with these situations (although to be sure trauma trained educators are rarely involved, a critical omission in my view).
Second, the number of deaths — unfathomable at 9/11 and Sandy Hook and Parkland and the Marathon Bombing and the Las Vegas Concert Shooting and Surfside and countless other disasters — - stands in contrast the number of deaths from the Pandemic. We can’t wrap our heads or our media coverage around such a massive ongoing disaster. We can’t see an end. We don’t have a clear beginning. Certainty moving forward is hard. We are all in essence involved. Every life has been changed; the Pandemic defies geographic boundaries. We feel out of control. We are inundated with death and a host of other losses: jobs, food, homes, social connections, touch.
Third, how as a practical matter, can we deal with the aftermath of a disaster like the Pandemic? When do we start memorializing? With each death? With each 100,000 deaths? With herd immunity? With large scale elimination of the Pandemic? With the booster vaccines we will all likely need? Sometimes lasts are so so large, we can’t figure out how to deal with them. So, we ignore them as a way of dealing with them.
Fourth, the Pandemic may be chronic and its impact lasting but we won’t find closure or healthy pathway forward psychologically until we find a place to memorialize, commemorate and deal with the chronic trauma that abounds. Mental health studies show a decline in mental health across all ages and stages during the Pandemic. Suicides. Addictions. Drug use. Depression. Fatigue (Zoom and Covid related). Perhaps we don’t want to deal with trauma this big; perhaps we hope it will fade away and get stuck under some rug somewhere. But, trauma doesn’t go away; it can’t be hidden in perpetuity; that is one of its hallmarks.
There is no rug big enough to hid the Pandemic’s impact.
We Need Solutions; They Exist
Start with this: we need to own — individually and collectively — the reality that we have and are experiencing the kind of chronic trauma rarely experienced in our individual histories. We need to name it and only then can we tame it. We have to recognize the price we’ve paid for the Pandemic (and there are some pluses to be sure); we need to recognize our feelings, howsoever painful and seemingly enduring. We need to know the impact this Pandemic has had on us as individuals, families, communities, regions, states and as a nation and a part of a global community.
So, first solution: we need to own this chronic disaster with the accompanying chronic trauma.
Then, we need to find ways at all levels and in all locations and for all individuals to memorialize the Pandemic. This means we need to plan and prepare for how we want to commemorate a horrific chapter in America and across the globe. The choices are endless and no one approach will work for all individuals, all regions, all people of all races and creeds and genders. But, we need to mobilize. We need to do some things. We can have temporary memorials that then lead to more permanent solutions. We need to tell stories about those lost. We need to share their pictures and the details of what made them the people that they were.
Then, we need to have hope. Hope is not a passive condition. It is not something we watch from a far. Hope is a belief and with that believe come action and activities and attitude adjustments. Hope is one of several established keys to recovering from trauma. And how to have hope and how to mobilize hope can come in different ways. For some, it comes through religion. For some it comes through the arts. For some it comes from speaking out and protesting. For some it comes from changing laws and approaches in anticipation of a future pandemic. For others it comes from effort to identify thoughts, feelings and behaviors we hope within ourselves and that others hold within themselves and then mobilizing around this.
And, many people can and do see improvements in how we do things since the Pandemic and that can give us hope too. Some people have slowed down and read more; some people have connected with folks they haven’t spoken to in decades; some have identified new ways to do things — art, music, education. Some people have learned new sports or new skills. Some people have learned to communicate more effectively. We’ve all, I think, found that somethings that were always done one way can be done differently and different can be better.
While we work on all this, here’s one suggestion. I carry hope in the form a ceramic stone with me. I carry extras so I can give them away. I give them to students (send them is more accurate). I rub the stone; I look at the stone. I use the stone to remember that hope is what we must have and that we must give that word meaning by animating it — in ourselves and others.
Here’s the stone I carry.
I have another five or so if any of the readers wants one. Reach out. Share your address and I will send it to you. First come, first to get the stone.
Consider this ceramic version of hope one step in our collective effort to address chronic trauma. Here’s my email: karengrosscooper@gmail.com.
