In the NAMI Peer-to-Peer nine-week education course, the mentors introduce the participants to the "Stages of Emotional Response to Trauma" and ask each of the students to assess where he or she is along this continuum. It is true that the diagnosis of schizophrenia is a trauma. My hospitalization in 1987 when I had my breakdown split my life into before and after. There was no turning back. Things couldn't go on the way they had. I adapted as best I could because resilience didn't come easy.
In the first week of Peer-to-Peer, the mentors suggest that when we are labeled and treated for a mental illness, the events leading up to the diagnosis hit us with "the full force of a tornado through our lives," leaving us confused, bewildered, uncertain, and frightened. Unlike tornado survivors, though, we are expected to take our medication and get on with our lives, as if nothing has happened. Or, as is also the case, "we have been given the message that we are so damaged by our illness that we are nearly incapable of anything anymore." We collapse "under the weight of the shame, the regret, and the lowered expectations of the people closest to us- who are as helpless as we are in the beginning to make things better."
If you are newly diagnosed, or even if you've been in recovery awhile, I want to revisit the stages of emotional response to trauma. A course like Peer-to-Peer is good for newbies as well as old hands alike. It holds that trauma is an integral part of the mental illness experience, and gives techniques for understanding and managing the impact of trauma on our lives.
Here now I will define and delve into each stage of emotional response:
1. Catastrophic Event:
Hoping Against Hope
Providers often use the word Crisis to describe an acute episode. We marshal reserves of courage to deal with the event. Chaos is how we describe our minds and our lives. Things are out of balance and we've lost our equilibrium. Shock takes many forms, including disbelief or numbness. We often have no words to express how we feel about what happened, because the episode came on suddenly and left us shell-shocked. The next, Denial, may be protective. We are aware that something traumatic occurred, but it is too painful to process right now. Normalizing comes on in many forms, such as resistance, "I'm perfectly okay and don't need any help," to despair, "I'm so not normal I'm beyond help." The Catastrophic Event stage closes out with Hoping Against Hope, which keeps us afloat in times of great hardship. We hope against hope that we aren't going to be sick all our lives. We have gone through the worst and begin to hope that things can get better.
In my recovery, had I attended the nine-week Peer-to-Peer course, I feel things would've been different, because, "If you name it, you can claim it," and I would've had words and terms to describe what I'd been going through all along. The Stages of Emotional Response to Trauma are a natural part of the healing process, and you can be in any of the three stages at any time, depending on what you're going through in your life then and how vivid the memory of the trauma is. When I first got sick, the very symptoms of the illness other people had rubbed me the wrong way because I didn't want to admit I had the same illness. The denial led to a failed drug holiday.
Adapting to our new reality takes time, and it may not be a natural response; however, if we decide to adapt, rather than expect or want things to continue as they were before, we actually liberate ourselves to have a better life. Here comes the next stage of emotional response to trauma, where we start to go from reacting to what happened to us by processing it, to proactively dealing with it.
2. Learning to Cope:
We are angry that we got sick; we feel guilty we got sick; we resent that we got sick. Our self-esteem takes a nosedive. This is the tendency to internalize the stigma, because most of us who are newly diagnosed and have just gotten out of the hospital aren't aware we have peers who've been in our shoes and traveled this rocky road, often successfully. Things are kept "hush-hush" as we go back out into the world and interact with people who don't have mental illnesses.
There is a power in a union; NAMI and MHA are advocacy forces to join with in fighting the stigma, as you evolve in your own recovery and find your voice.
Recognition sets in when reality flashes before our eyes and we realize we'll have to manage our condition for the rest of our lives. Yet medication isn't everything. It's the foundation, true, for a stable recovery, yet there is so much more to life than popping pills: relationships, for one.
As we learn to cope, grief replaces the rest of our feeling functions. We get stuck in "what was" instead of "what can be." When I was diagnosed, I pined for the cheerful, gregarious self; the person who dared to become a disc jockey because she loved music and wanted to express herself. I went back to the on-air studio for one sad summer, and gave it up because it was too painful to bear the truth: my life had changed, and I had to move on.
Each of us is the expert in our own recovery, and that is why I urge you to write SharePosts talking about your coping techniques or how you healed and what you learned along the way. As we learn to cope, and indeed, become experts, we enter the third and last stage of emotional response to trauma.
3. Moving Into Advocacy:
Now we are able to understand what has happened and what may be. We accept the illness as "companion" and a guide that has much to teach us. We are okay with this. We decide whether we want to quietly go about our lives and do what it takes to live well, or speak up and be an advocate, in service to our peers and others in the community.
As you could guess, I consider myself in the center of advocacy. Yet at times, there's "catastrophic event" thinking or "learning to cope" mechanisms. I want to talk about something I've observed along the continuum of stages of emotional response to trauma. I realized that at times of unease, I was celebrating an anniversary or revealing myself, or undertaking some great emotional work in my recovery.
Those times were when I disclosed, or faced a truth head-on. In September 2004, a month after I was the featured reader at the Cornelia Street Café poetry event, where I read the breakdown scene from my memoir, I had a mini-meltdown traveling into the City again. In July 2006, when I started the exercises in the Artist's Way, Julia Cameron's book on creativity and recovery, I uncovered things that left me vulnerable, too.
I would tell you or anyone to rely on your close friends for support, examine what's going on, and know that the feeling is only temporary, you'll get through it, and other feelings will come up in its place. Such is the nature of life, and of living with schizophrenia.
So as you move from stage one through to stage three, know that your responses to the trauma are natural. As you advance in your recovery, some things will come easier to you because it gets better with age. Next week, I'll be blogging about "Recovery at Mid-Life" because I want to instill hope for the future.
There is hope.
Published On: May 22, 2008