What Happens Next? Understanding Trauma

I am writing this in support of the many families and employers putting the pieces back together after a shooting in a high school.

It has been two weeks since the shooting, and the last child in critical care, passed away last night. Every child passing away, has torn our hearts open with grief. The grief is enormous.
This is a time for tears.

And each time we grieve, we need to again find some way to hold ourselves together when we aren’t sure we can.

 Our previous traumas may reopen and we seem to be lost in an old, but familiar place. A place that we thought had passed. It did pass, we did heal, but then we aren’t sure. The grief and sorrow can only be felt. That is all we can do with it. Feel it.
It is like the weather. You can’t go outside and make it stop raining. You can’t ‘control” the grief. You just feel it. It holds on until is ready to let go. You can’t make it pass.

Sometimes people want to make the grief pass quicker or just go away. Getting angry or frustrated at grief doesn’t help. It may make you feel worse. It is ok to just let it be with you. It lifts when it does.

Each person going through this trauma is going to have their own experience with grief. It won’t be the same from person to person.
We all need to be patient with this.

We aren’t sure if we should push someone out of bed, or if we should do homework when we can’t think. 
We need to make adjustments for the next few months.
If your concentration is shorter or hard to concentrate at all, that is normal after trauma. Your mind may be unable to focus.  Listen to what you need. If your mind needs a break, take them as much as you need. You will heal if you listen.

Do your normal routine when you can. This may not be right away. Everyone needs a very short list of just a few things they can do that are part of their routine. Make a short list. Take breaks from the routine when you can’t do it. It  may feel like you are pretending to be normal. That is ok. That is how we get up. We just do what we are able.  And when we are not able, do not be afraid.
It may feel like we can’t be or do  our “normal” things. Don’t be afraid of that, it doesn’t mean you are broken, it just means that you need more time.
Trauma and grief can have a timelessness. Trauma and grief are not really grounded to the clock.
And yet, for those closest to the shooting, they will find themselves looking at the clock often. Looking for that exact time of day, that particular day of the week. It will be significant for now.

Now is an important time. When we become lost in grief, we will find our way back eventually to “Now”. This will help us with healing.

There are no right ways or wrong ways to cope with this. You have some instincts inside telling you what you need. It may sound different than what you think is ok. But listen to those instincts. 

I heard a parent who was in a different school district receive a letter home saying "talk to your child about the shooting". She said, "My child is 5 years old and this doesn't make any sense to me." I told her to listen to her instinct. This is a time when messages from experts or people in a authority are trying to help but they may not really know what is right for you. You do know what is right for you and this is the time to listen to your inner wisdom. Even if you are unsure. Trust that. It is ok to do what is best for you. 

Someone else said they need a few days off from work. They are having trouble returning to work at the hospital. Many people are feeling this way. It is hard to return to the place of the trauma. Employers may be able to understand this, reach out to the HR department and have some conversation about this. They may have some support to offer.

For any family member associated with the school, with the surrounding community who interacts with the families, with the hospitals and their staff, with the emergency responders, with the district leaders and tribal leaders and tribe; there is a tremendous amount of healing in front of us.

Our kindness and open heartedness will help those who are suffering the most. We need to keep bringing that and do activities that let our hearts touch each other. This is how we can help right now.

It may be hard to let the joy in. But the kindness has been lifting hearts and we need to let our hearts raise when we can. Some people get angry when their heart begins to raise, but this is the time…to follow your heart. It will lead us through this.

Finding Words to Talk about This

This is written for my friends at Tulalip, in support and love.
It is also written for everyone touched deeply by the tragic shooting.

As we read brief public statements about Jaylen, a young 14 year old, who was beloved in his community and family and by all accounts a leader and rising star, we are struggling to understand what could trigger such an episode. As an entire community struggles through this with two teens dead and several critically wounded, we are all going to need to find the words to talk about this. 

 Our own struggle to find words is exactly what happens inside of a child or teen who is struggling with an emotion. They often can’t find the words.

Most of us can recognize very obvious clear signs of depression. But the truth is that depression in children and teens is completely different looking than in adults. It can be extremely hard to recognize. It can also take a long time for a child or teen to give us the words for what is going on inside.

Depression is even harder to recognize in children and teens because it can come on very quickly. When depression slams a child down hard and fast on the inside, they can experience a sudden break from reality.  Once they have lost touch with reality, they can hurt themselves and others. We can tell that there is a break a from reality when everyone who knows the child or teen describes the child as normally very engaged and participating and social and getting along well with others. It is the bizarreness of the episode that gives us the clue there was a sudden and sharp break from reality.

A child or teen who has not experienced depression, would not recognize that they are in a bad place inside. If they have had a break from reality, they would not be able to call out for help, because they often don’t have the words to describe the experience. We don’t know what is happening and they don’t either.

It takes extensive work with children and teens who struggle with depression to learn ways to talk about what they are experiencing.  This is something teens learn, not something that would just come naturally to them. For a teen who isn’t usually struggling with depression, they might not have any way to recognize this is happening.

This is hard to talk about , but our children who are stars are just as vulnerable to depression and a break from reality as any other child. Our gifted and talented kids struggle to always be successful and sometimes when they experience pain or hurt inside, they aren’t sure they can survive it. 
At this time, we can only do exactly what we are doing. Take care of the wounded. Pray. Grieve. And help each other with the trauma.

What if someone has a psychotic break from reality?

Every now and then I receive a call from someone who has had a significant break in their mind- it is like a bone breaking, except it takes place in the mind.
It is called a psychotic episode, or having a "breakdown", or going over the deep end.
Whatever you call it, when you see it or experience it, it is very serious and very scary.

How to recognize it:
1- The person is repeating a thought, over and over. It is like their mind is stuck going in a circle. They are repeating one or two sentences again and again.
2- The person is not making sense. The things they say are not logical. The things they say are bizarre in a way that people listening would be very concerned.
3- The person strongly believes their bizarre thoughts.
5. The person can't do life tasks. Things they used to do, they can't do.
6. You are worried they are so depressed they could kill themselves.

You don't need to see all 6 of the ways to recognize it.  Any of these is reason to be very concerned.

What to do:
1- Take the person to an EMERGENCY ROOM. Get a mental health assessment to determine if the person needs to be hospitalized for a few days to help get them safe and stable. There are hospitals that have good inpatient psychiatric services, check to be sure the hospital you are going to is set up to provide help. If they aren't they will tell you the names of hospitals that can help.
2- Call the doctor or nurse practitioner to get referrals for a "good psychiatrist".
3- Call the health insurance company to get an urgent care referral for psychiatric help.
4- This is an urgent situation and is best if treated very quickly with medication and psychiatric support.
5- Do NOT leave the person alone to be by themselves EVER while they are sounding psychotic, bizarre, not making sense. This is why it is important to take them to a hospital for care, they can hurt themselves  or others if they are left alone.

Getting a treatment team is essential:
1- Sometimes people are very resistant to getting help. Do not let someone who is psychotic decide if they need help or not.
2- Be supportive of using medication. It can be very scary to go through this and the treatment team may need to use medication to help stabilize the brain.
3- The medication can be scary, especially if you do not have experience with this. Ask the treatment team about the medications that are used and how long they are usually used, and why they are using the medication. While going through figuring out which medication can help, sometimes people are heavily sedated at first.
Again, ask why they are using a high sedation. I find that when people understand why and how the medications are used, it can be helpful. Sometimes the care team does not explain this, so ask to help you understand.

How you can help:
When a person has a psychotic break, they need responsibilities lifted while they recover. It is best to stop all responsibilities and just take care of things while the person's mind is resting.
Be patient with the person that is recovering. They may not want to take medication, they may not want to go to appointments, let them know they can stop doing all of that as soon as they are better.
Be very reassuring that they will get better.  This is incredibly scary to the person going through it.
It helps to tell people: THE MIND HEALS SLOWLY.

When you break a leg or arm, we put the limb in a cast to hold it still so the bone can heal. The mind is similar, when it breaks, we need to hold it still, give it a rest, take the pressure off. Sometimes this can be achieved with the use of medications. It allows the person to sleep, etc.

Long term:
While the person is healing, when they are strong enough, the treatment team will help figure out when the person is ready to learn the life skills for the issues that overwhelmed them. There are usually things that have been building and building internally that the person needs to work with. When they are ready to do the work, then it is important to work with a therapist or the psychiatrist that the person wants to work with. It can be very hard to trust a new doctor or psychiatrist and people may be fearful of the care team recommendations. It is OK to get second opinions. Please call a therapist you trust or a doctor you trust who may have experience and help prepare you for what to expect. This person could consult or advise you. It is very helpful to talk to someone you know and trust in the medical profession. They can provide very valuable advise.

Getting a Treatment Team:
It can be very hard to get appointments. Many people have waiting lists. Not all of the providers will be taking your insurance. It can bey very expensive to get help. It is essential that you get help- therapy for yourself if you are taking care of someone who has had a psychotic break. It can be very confusing and hard to make decisions.

If children are in the situation, it is important to make sure the person having the psychosis is not responsible or alone with the children until they are feeling better. If the children or teens are alone with this person, they will be made responsible to take care of an adult without really the "authority" or skills to "manage" the adult. Please do not leave children or teens alone in such a situation.

Healing takes time. I have seen many people have a full recovery from psychosis if they get help, treatment, and support. It is important to be sure you are getting an accurate diagnosis. Sometimes other things do need to be evaluated and treated.

People always ask me this, especially other therapists

People always ask me, "what is like to be a therapist in a small community?"
I received a phone call today from someone seeking counseling for their 18 year old. The mom of the 18 year old left me a message and I called her back, knowing my practice is full and I will need to refer her to someone else.
When I spoke to mom she said, " I live about an hour away from you, but when I was 17, you were my counselor."  (Oh my god!- How cool is that?!)
 "I remember how much I learned from you and wondered if you could see my 18 year old daughter?"
When she told me her  maiden name of course I remembered her. I also worked with her parents a long time ago, who are now the grandparents of the 18 year old.
She then went on to tell me exactly what she gained from therapy 25 years ago. Here is what I learned in therapy..... Believe me, I am always amazed when people report back decades later and tell me how much the work sticks with them.
We both knew it was 25 years ago to the month that I last saw her, because the last time she saw me she said I was pregnant and just about to have twins!
We laughed together and talked more.
That is what it is like to be a therapist in a small community. It is meaningful.
I choose it because of the interconnectedness.
I know the closeness is not for everyone, but I choose this intentionally.