I attended a medical school that embraced the interrelation of social factors and individual thought and behavior. Not all medical schools espouse this philosophy. In fact, we had a separate course that was required in the curriculum. All of us – whether we were initially believers or not – found the course to be invaluable, if not transformative. The lessons covered the idea that patients' psychological and mental attitudes significantly influence their clinical outcomes.
In other words, the same patients with the same situations medically, do not always get better. Furthermore, the influence of those patients’ outcomes on us as healthcare providers affects us as human beings as well. Lastly, we were taught that the healthcare providers’ attitudes can affect how well our patients do.
What is collective trauma?
The concept is that being exposed to real or threatened stress or injury changes us. The perception of and the complexity of the interactions of psychological and neurobiological factors weave into our health and well-being.
The collective trauma of our world today has posed significant challenges to all of us. We have no choice but to face collective trauma. The key is how we manage it.
What are the signs and symptoms of collective trauma?
There is a lesson we learn in basic biology. It has to do with a frog. If we place a frog in water, it adapts to its surroundings. If the water is slowly heated, the frog will stay in place, making the best of it. Unfortunately, after the water gets too hot, the frog begins to suffer and still does not move. However, take the exact same frog and place it in scalding hot water to begin with, and it will jump. That frog feels the instant offensive heat and flees.
With collective trauma, we become complacent like the frog in the slowly heating water. We suffer with the onslaught of unpleasantness.
Between the COVID pandemic, systemic racism, climate change, economic instability, and inequality, and gun violence, our world like the frog’s water is slowly coming to a boil. And that is a pun intended when referring to climate change.
Many of us can experience one or more of the following:
- Persistent intrusive thoughts related to the traumatic event or potential trauma.
- Nightmares or distressing dreams.
- Persistent or recurrent involuntary memories.
- Intense, negative emotional or physiological reactions.
- Avoidance of traumatic triggers or of thinking/talking about the experience.
- Negative alterations in cognition and mood.
- Persistent negative beliefs and expectations about oneself, others, and the world.
- Inappropriate blaming of oneself for the trauma.
- Exaggerated negative beliefs about the consequences of the trauma.
- Persistent sadness, horror, or guilt.
- Loss of interest or participation in important activities.
- Feelings of detachment from people.
- Irritability, problems with sleep or concentration.
- Increased startle reaction.
- Increased vigilance for potential danger, self-harming acts, or recklessness.
What may make one more susceptible to collective trauma?
Existing factors include the following:
- Gender (increased in women).
- Prior traumatic exposure.
- Existing mental illness.
- Lower socioeconomic status.
- Less education, lower intelligence.
- Childhood adversity.
Some of the factors that affect how we manage the collective trauma include the following:
- Severity and nature of trauma.
- Interpersonal violence.
- Dissociation at the time of the traumatic event.
- Increased pulse right after the traumatic event.
Many of us may know someone who had COVID, but the effects do not hit home until the person, or their family is directly affected by the trauma of the infection, hospitalization, or worse, death.
Some of us may think about racism or gun violence affecting communities, but if they experience the adverse effects personally, the trauma reaches a whole new level.
What are the effects of collective trauma after the traumatic event?
Posttraumatic factors include the following:
- Development of Acute Stress Disorder.
- Other stresses such as financial problems.
- Subsequent adverse life events.
- Lack of social support.
How does collective trauma affect us biologically?
Just like for post-traumatic stress disorder (PSTD), it is believed there can be changes in the anatomy and neurophysiology of the brain. The part of the brain that engages in processing emotions and modulating fear is the amygdala and it can become overreactive.
A part of the brain called the medial prefrontal cortex, which normally exhibits inhibitory control over stress and emotional reactivity of the amygdala, can actually become smaller and less effective.
There are theories that neurohormones and neurotransmitters can lessen their effectiveness. People can experience hyperactivity of their fight or flight responses or the sympathetic branch of the autonomic nervous system. This can translate into changes in heart rate, blood pressure, skin conductance levels, and other psychological stresses.
A variety of other neurotransmitter systems, such as the serotonin, GABA, glutamate, neuropeptide Y, and endogenous opioids, can show altered functioning.
Further insight into what happens when we are exposed to collective trauma relates to our memory. We have verbally accessible memories, and we can modify these memories by reflection. We also have situationally accessible memory, which is non-verbal, and these can elicit extraordinarily strong emotions. Collective trauma tends to be situationally accessible, and therefore harder to process.
Many of us today are experiencing direct exposure to traumatic events or the potential of trauma. Either way, these traumatic experiences can have a significant impact on our view of the world and on ourselves.
What can we do about collective trauma?
Prevention is key. Reducing our exposure to traumatic events, even if it involves avoiding the trauma, may be the best and most effective method.
The problem is that avoidance may not be practicable or possible. All of us, for example, will have some form of COVID infection at some point.
There are many psychological tools such as cognitive-behavioral therapy and group counseling which may offer benefits. Medications can be helpful, but careful monitoring by a healthcare professional is mandatory.
The best defense for all of us in these turbulent times is elevated levels of emotional support and help with basic needs for shelter, food, clothing, and economic issues.