Trauma

When we face acute traumatic stressors like climate disasters, legislative impacts, or a pandemic, we are experiencing a direct threat to our life or the lives of others we know. We are all either vicariously witnessing trauma, through media or through supporting others, or directly experiencing trauma, by becoming ill, isolated, or experiencing the plight of close others. We all know, in some vague way, that “normal” continues to change, and the world will never be the same. 

Even more, frontline providers and essential workers are at risk of developing traumatic stress symptoms. These acute stress reactions are natural, but it is important to promote self-care, social support, and sleep, to prevent prolonged psychological consequences such as post-traumatic stress disorder and depression. These serious reactions are more likely to occur in people with a history of trauma, especially childhood trauma, but we can take steps to protect ourselves and minimize the negative consequences. Resilience and healing from trauma is something that happens best in the context of supportive relationships. 

Loss can occur in many different ways. You may experience the death of a loved one, family member, or friend. Perhaps you lost a relationship, friendship, or career. In global crises where you experience sudden change (such as the COVID-19 pandemic), you may experience a communal sense of grief at the loss of how things were, and anticipatory grief at the threat of loss of life. 

When experiencing a crisis, you may feel what is called "moral distress." This is an expression of anger at witnessing injustice. These emotions are natural and common. However, it can lead to shaming and blaming, and is not necessarily helpful to the person suffering. 

Moral injury is also common in both personal and global loss. This is when an individual witnesses or cannot prevent acts that transgress their moral beliefs. In these intense states, we feel our integrity is violated. This phenomenon is described well by the humanitarian Joan Halifax (who also has tips for coping with moral distress). In this section, we have asked several acclaimed experts about these sensitive and critical issues to share helpful education and tips.

For coping with all of these issues, we emphasize ‘trauma informed” strategies: 

• Use strategies to reduce stress throughout the day, including statements that support a resilient mindset (radical acceptance, self compassion, positive challenge appraisals), as well as mind-body exercises that reduce stress reactions such as breathing exercises, meditation, physical activities, and social support. 
• Recognize and reduce traumatic reactions. During a webinar, UCSF's Alica Lieberman, PhD, and Edward Machtinger, MD, described traumatic stress—including how it is different from typical life stress, how it can lead to avoidance and emotional numbness and shame, and how to manage it. It is important to help patients, providers, and staff feel safe. Encouraging the early seeking of care is crucial. 

Understand organizational and community perspectives. It is helpful to realize that in response to large scale disasters and traumatic events, solutions must be communal and not just individual (like one-on-one therapy). As noted by Jack Saul, PhD, communal perspective provides outlets such as community peer support groups, ritual, art expression, and safe environments.  Trauma-informed practices and principles help make people feel safe and thus more regulated. It includes prioritizing relationships (as social support and connection can buffer stress responses), creating physical safety (a safe environment decreases the stress response and ensures rational thinking, judgement and attentional control can occur), and emotional safety (to help staff understand what to expect).

From Michael W. Rabow, MD, and David Bullard, PhD 

We can be hurt by what we bear witness to in others. In caring for others in a crisis, we can experience secondary trauma. Repeatedly seeing and hearing about, working to ameliorate or treat the traumatic losses experienced by others, we are at risk of being traumatized ourselves, going beyond just empathy for another’s pain to an actual vicarious experience of suffering and trauma. 

Numbing and compassion fatigue are when emotional and physical exhaustion sap our ability to empathize or to feel compassion. Compassion fatigue can be the unwanted, uninvited cost of caring. We are often advised (appropriately so) by a series of platitudes that are, nonetheless, absolutely true: “put on our oxygen mask first,” “prioritize on self-care,” especially as we reckon with the fact that “this is a marathon, not a sprint.” We must sustain for the long haul, or at least refuel for the next wave of challenges. 

Survivor guilt is an unfounded sense that we have done something wrong by surviving a tragic event. We are hurt by what has not hurt us. This feeling can be both rational and irrational, conscious and unconscious. We can feel this way by watching close family, siblings, friends, or lovers suffer from what we have escaped. Or, we can feel this way by watching people we don't know, parents, or children across the globe struggle from what we have survived (ex: gun violence, a deadly virus, climate disasters, etc.). 

We can even experience an invisible but well-documented version of this emotional response called unconscious survivor guilt. Some manifestations of this can be one's thoughts acting as tools for self-punishment. This is a common response to the perception that we have fallen short of our natural and even hyper sense of responsibility for the lives of others. Rumination and worry are exaggerations of thoughtful self-reflection, and contribute to feelings of unease and depression, distorting the natural sadness and grieving that are inherent in our humanity, and robbing us of joy and delight in our own present moments of precious living. 

And here again, the advice is repeated. Though it has become commonplace, even cliché, it remains true: recognize your feelings are normal (and common); realize you are not exempt and there will be time still for us all to feel losses that we might deem big enough; and, if you can, pay it forward. If you have had good fortune, you can dedicate yourself to having your life and work be an honor to those who have not had such luck. Let yourself find moments of peace, connection, joy and love; they can be valuable treatments for the wide world of pain and suffering. 

Ultimately, be gentle with yourself. Be compassionate to yourself for the losses that anyone might see in your life, for the invisible suffering only you can feel, and for your place in the misery of what has befallen us all in a million inexplicable ways. 

Whether on the frontlines or the sidelines, kindness and taking care of yourself allow you to be compassionate with and to provide deep help to others. Kindness and self-care, most of all, allow us to see the sacrifices and contributions that we and so many are making and to feel our connection to all humankind. 

A poem about what we can and cannot do 

Medium is a platform where stories, knowledge and wisdom are shared to deepen a collective understanding of the world through the art of writing, something poet Bria Rivello wrote in the poem, “The Art of Acceptance”

The Cope Program offers mental health and well-being resources specifically for current UCSF staff, faculty, trainees, and their family members to provide additional mental health and well-being support to our valued colleagues who are experiencing distress. These services are available to all UCSF populations mentioned above, regardless of their personal health insurance carrier or status.

The UCSF Cope Program uses a simple and confidential digital health tool to connect UCSF employees with a wide array of emotional support services. It can be accessed online or by texting “@Cope” to 1-833-319-1084.