Dr Jo Stubley – Introduction to Trauma and the Current Pandemic

Hello my name is Jo Stubley, I am a Psychiatrist and Psychoanalyst and I run the Tavistock Trauma Service. I am aware in these difficult times that many NHS frontline staff may well be experiencing a number of traumatic events, and I thought it might be helpful to say a little bit about that today.

So what do I mean when I’m talking about this idea of trauma? Well I think at the heart of this is an experience of helplessness, and that can be really difficult for NHS staff who are used to doing the things, not to feeling helpless. I think the other aspect of trauma is that it is often something that is overwhelming, so that our usual ways of coping no longer work. Now that might be a single episode of something terrible happening, either that you witness or that you are involved in, or sometimes it can even just be something that you hear about. Trauma though can also be cumulative, so it may be something that small but significant episodes build up over time. What is traumatic for one person may not be so traumatic for the other, it is often a combination of that particular moment for that person, with their history and if we have a lot of trauma or difficult losses in our background, that may make us somewhat more likely to develop some symptoms after a traumatic event. It might also be that trauma occurring now can link up with these earlier experiences and one might find that earlier losses or traumas get brought to the forefront of one’s mind again.

So, in relation to thinking about the kinds of symptoms that you might have having had something traumatic happen. First of all I want to say that it is very normal after something traumatic occurs to have a number of symptoms that are not part of a mental health issue, they are a normal response to an abnormal event and for the majority of people will settle over time, particularly if one is able to use self-care and the supports that are around. The sorts of things that we find might get activated after a traumatic event come under three main headings:

1. The first we might call anxiety or hyper-arousal. This is like the fight-flight response; a threat is perceived and one has something activated inside in terms of our body’s response to threat that keeps happening, so you can feel agitated, distressed, find it difficult to sleep, might have moments of real panic. These are the kind of symptoms of anxiety and hyper-arousal.
2. The second type is those of re-experiencing symptoms, the reliving of the traumatic experience which might be intrusive images that come to mind, it might be intrusive thoughts, it could be nightmares or even flashbacks, where one relives over again what is happening and these things are often triggered by something in the environment that reminds us of the event, quite often it is smells that are particularly powerful for that.
3. The third type is avoidance and numbing, and it is a way that we kind of shut down a bit, we don’t feel as much, we may not wish to talk to people, we may wish to avoid having interactions or even going back to work, and that is often a way of trying to shut down these symptoms, not get triggered, not feel so over aroused but can be problematic if one feels too much like we want to avoid.

Now all of these symptoms are normal, they are the kinds of things that over time will settle, but it is important to think about what can be done in the meantime. The first thing to say is that all of the evidence suggests that people recover from this much more easily if they feel they have a good social network around them. Now I am aware that that means at the moment we have to work particularly hard to hold on to that because it mainly has to be virtual, but it does stress the importance of keeping our connections in this difficult time. The other thing that is really important is to think about basic areas of self-care; diet, exercise, as much sleep as possible, not using alcohol, prescription or illicit drugs to try and manage these things, the kinds of basics that are really important to come back to.

We will be talking more about how to think about trauma but I hope that this brief start is something that can be helpful for you, thank you.