Reflections on Florence: Trauma Influencers

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As the Wilmington community licks our wounds and clings to any semblance of normalcy, something may begin to rear its head among us: trauma. As a trauma specialist, I often remind myself that when your favorite tool is a hammer, “everything looks like a nail.” However, when I think about Hurricane Florence, there are two things I know: 1) hurricanes are natural disasters and 2) natural disasters are traumatic stressors. They are even included in the DSM-V’s examples of traumatic events, alongside being taken prisoner of war or surviving a terrorist attack. I include this because after events such as Hurricane Florence, it is common to minimize situations in order to help them feel less overwhelming. While this can be a helpful coping strategy, it can also lead people to ignore signs that they need help. And as we have discussed before, asking for help is not a sign of weakness, it is a sign of strength.
There also can be an invisible hierarchy when it comes to traumas. Sometimes we use this hierarchy to determine if the severity of an event is “bad enough” to be labeled as traumatic. This type of comparison can often lead to minimizing or overlooking significant signs and symptoms of trauma. Make no mistake, the type of event does matter when it comes to trauma. However, simply estimating outcomes by the severity of the event is a gross oversimplification. There are a whole host of variables that influence how significantly an event will impact a person. We may never completely understand how or why events can trigger a trauma response. However, there are themes in the psychological theory and research on this topic. I would like to reflect on a few of these themes that seem particularly relevant in the wake of Hurricane Florence.

Proximity

How close we are to an event impacts how traumatic it will be. The closer our proximity, the greater potential for an event to be traumatic. There are many different levels of this continuum. There are people who experience the event directly. There are people who experience the event over different types of media. There are people with loved ones who experienced the event directly and so on. The closer you are to the event itself or the closer you are in relationship to the people in the actual event, the greater the trauma risk. People who experienced the storm first-hand had very different experiences than people in another state whose relatives evacuated from the storm. This does not mean that those outside the path of the hurricane are exempt. It does mean that the closer you are to the actual event, the greater the likelihood of trauma. The proximity factor also interacts with other factors as we will see below.

Injury and Death

At the time of this post, the most recent death toll for Hurricane Florence is 50 and the number of physical injuries may never be clear. Deaths related to traumatic events can trigger traumatic reactions in the loved ones of the deceased. Again, the proximity rule applies here. The closer the relationship to the person who died, the greater the risk for a traumatic reaction.
Physical injury is also one of the most significant predictors of a trauma response. This is particularly true following a natural disaster. People who sustained physical injuries (i.e., physical trauma) during or in the wake of the storm, are at greater risk of psychological trauma.
Another factor that is very significant in traumatic events is the fear of death. In addition to the people who actually died during the storm, there are countless others who feared for their lives or the lives of their loved ones at some point along the way. Fear for your own life or the life of a loved one is one of the most significant predictors of a trauma response following a natural disaster.

Loss of property

Another significant predictor of a trauma response to a natural disaster is loss of property. This is a feature that is somewhat unique to natural disasters. In many other types of trauma, there is fear of death or injury; but in natural disasters there is also a risk of losing some or all of one’s possessions. In the aftermath of a natural disaster, there can often be a pull to minimize the significance of possessions. After fearing for our lives or the lives of loved ones, it can seem silly or petty to be upset over things that are “replaceable.” It is true that losing one’s home pales in comparison to losing a loved one. However, this does not mean that losing our belongings is insignificant. On the contrary, the research in this area consistently shows that greater property loss during a natural disaster significantly predicts an increased risk of psychological trauma.

Age

Age is an important factor regardless of the type of trauma. This is one of those psychological findings that most people know intuitively. It is one of the reasons why children are considered a protected population. Children are more vulnerable to physical and psychological trauma. There are a number of reasons for this. Children’s brains and bodies are not fully developed. Their brains and bodies are actually in the process of developing and aversive events have the potential to significantly disrupt this development. Children also typically have a lower capacity for coping or managing stress than their adult counterparts. All of these factors elevate the risk of adverse reactions to trauma.

Personal History

Every person who experienced Hurricane Florence already had a life, a story, and their own level of stress before the storm. This is important because of the cumulative nature of trauma. Multiple traumas across the lifespan are often greater than the sum of their parts. The old triggers the new and the new triggers the old. Maybe this was not your first natural disaster. Maybe your family and possessions were fine during this storm, but it brought back memories of losing your home years ago. Maybe you have major conflicts with your family and you had to live with them in a hotel room for three weeks. Maybe you have family members who did not even reach out to check on you in the wake of the storm. There are endless possibilities in which this storm may have exacerbated or dredged up old wounds. Events in our lives that seem unrelated often have a way of bumping into one another in unexpected ways.

Final Reflections

This by no means is an exhaustive list of all the factors influencing traumatic events. But I hope that this reflection gives you a glimpse into the complexity that is trauma. Sometimes it does not make sense on the surface why one person appears fine and another is struggling. Trauma is like an iceberg in this way. There is so much below the surface that we cannot see.
While reflecting on the factors that make natural disasters unique, one word kept coming to mind: community. Natural disasters are different from other stressors in many ways that make them more difficult and far reaching. There is one facet of them that I think makes them more bearable. Each of us that was impacted by this storm will forever be connected by the experience. One of my favorite Albert Schweitzer quotes refers to “the fellowship of those who bear the mark of pain.” As a community, we are united by our pain, our loss, and our love for this corner of the world. Trauma is often very isolating and lonely; but I for one am so grateful for the people in my community who have walked through this experience with me. It has helped make the pain and loss feel lighter than it would if we had to carry it alone.

References and Resources

Briere, J. N., & Scott, C. (2014). Principles of trauma therapy: A guide to symptoms, evaluation, and treatment (DSM-5 update). Sage Publications.

Kilmer, R. P., Gil-Rivas, V. E., Tedeschi, R. G., & Calhoun, L. G. (2010). Helping families and communities recover from disaster: Lessons learned from hurricane Katrina and its aftermath. American Psychological Association.

Tedeschi, R. G., & Calhoun, L. G. (2006). Handbook of posttraumatic growth: Research and practice.

Van der Kolk, B. A. (2015). The body keeps the score: Brain, mind, and body in the healing of trauma. Penguin Books.

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