In the Aftermath

Processing Trauma through the Lens of Lament

Photo by Nur Andi Ravsanjani Gusma

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How deserted lies the city, once so full of people!

How like a widow is she, who once was great … Lamentations 1:1

So begins the great lament of Jeremiah, a prophet whose life work was to warn God’s people about the worst possible tragedy, then watch it happen anyway.  I have been reading through Lamentations off and on in the aftermath of Hurricanes Katrina and Rita, and now Wilma.  It seems that the image of Jeremiah wandering through the ruined city of Jerusalem serves as a poignant visual metaphor of New Orleans, Biloxi, and the many other communities devastated by these storms.  The reflections of my friend Chris, who spent two weeks serving in direct relief efforts in the worst areas, sound something like Jeremiah’s opening statements.  He describes driving down neighborhood streets where doors are marked with the number of dead found in each house and the smell of death is consuming – a more than overwhelming scenario.

We’ve been reminded at FYI that the impact of the trauma our country has sustained will be deep, systemic, and long-lasting.  There has never been a natural disaster of this level in America.  The unfolding of events following Katrina have left many questioning the quality of leadership at local, state, and federal levels.  Those who believe in God find themselves asking very serious questions too.  How could this happen?  Can God still be good?  Who can we trust to help us?  How can we ever feel safe?

For youth workers, it’s quickly becoming obvious that the realities of the hurricane aftermath will have both short and long-term impact no matter where we are geographically.  Cities and churches across America are welcoming refugees into their communities as well as providing the financial support needed to “adopt” displaced families.  Volunteers are going to devastated locations to serve, and some are returning to their home communities with little or no opportunity to debrief.  Even for those who do not know anyone directly affected, the general level of fear and unease has risen significantly across the country.  Every youth ministry in America has been, and will continue to be, touched by this catastrophic event.

So what do we need to be prepared to deal with as youth workers?  On one level, there’s a temptation to block out the inundation of hurricane-centered material.  Kids may be tired of talking about it at school, and everyone’s exhausted by the media’s graphic coverage.  Students’ first response may be to shrug off questions about how they are processing events, or to seem ambivalent about the endless prayer services for victims.

On another level, we need to be aware of the very real stress this has produced in students’ and families’ lives.  At the very least, the news coverage has saturated us.  At the most, kids you know have lost family, friends, property, and stability.  They may be moving into your community, or it might be your community.  We want to offer you some practical tools for addressing the trauma-related stress responses that may show up among the adolescents in your care, and to suggest the important role of lament in the process of healing.

One of our FYI researchers, Dr. Cynthia Eriksson, specializes in the area of trauma and posttraumatic stress.  Her study in this field proves especially insightful in helping students, families, and churches work through the aftereffects we are now experiencing.  Research shows that in the wake of a major disaster, school-aged youth are the group at greatest risk for developing severe psychological reactions. 1 These stress reactions can greatly interfere with kids’ abilities to carry out the normal functions of daily living.  We asked Cynthia to help us pass on some essential tools as you help navigate symptoms of posttraumatic stress that might linger in your ministry.

So, where do we start to look for signs of trouble?

As work is needed to begin physical rebuilding in devastated areas, the same is true for emotional rebuilding. Any tragedy involves loss, and for some people this loss is extreme as they try to imagine starting over from nothing!  For others, they feared for their lives and the lives of loved ones, and it’s difficult for them to feel any sense of safety.  Research from other large-scale disasters tells us that there is a range of common reactions that survivors can expect in the aftermath of hurricane Katrina.  Here is a brief list: 2

Emotional and Cognitive Reactions:

·      Feeling hopeless about the future

·      Feeling detached from others, feeling numb

·      Difficulty concentrating

·      Feeling jumpy and easily startled, on guard

·      Having upsetting dreams

·      Feeling nervous, scared, sad

·      Avoiding things that are reminders of the hurricane

·      Being irritable or easily angered

·      Feeling agitated or easily upset

Physical Reactions:

·      Stomach problems, change in appetite, overeating

·      Trouble sleeping

·      Fatigue

·      Racing heart, rapid breathing

·      Headaches

·      Not taking care of oneself (exercise, diet, health care)

·      Substance abuse

·      Worsening of existing chronic medical conditions

Spiritual Reactions:

·      Anger at God

·      Questioning God’s goodness

·      Difficulty finding meaning in life’s events

·      Difficulty trusting

This might seem like an overwhelming list, and it certainly can be overwhelming for survivors to attend to the day-to-day tasks of living while they experience the range of reactions. However, for most people these reactions will subside over time. Yet those who continue to struggle may have problems such as alcohol or drug abuse, depression, suicidal thoughts, or posttraumatic reactions that interfere with school and relationships. Severe emotional or behavioral problems need attention and support from both the adolescent’s support system and from professional mental health staff.

Which youth are at highest risk for more severe problems?

Those who are grieving lost loved ones, who have lost their homes, who had pre-existing mental or physical health problems, who faced an imminent threat to their life, or who witnessed grotesque scenes of the destruction are the survivors who are at the highest risk for developing chronic symptoms. These are the ones who may need professional help to work through their recovery.

Will we know PTSD (Post Traumatic Stress Disorder) when we see it?

Posttraumatic stress has become a buzzword in the media, related to terrorist attacks, the war in Iraq, and the recent tsunami. It is important that we understand that people can be deeply affected by a life-threatening event or a tragic loss.  However, just because people are developing symptoms of posttraumatic stress after an event, others assume that they are developing the disorder.  The problem with immediately applying the psychiatric diagnosis of PTSD is that potential helpers become fearful that they will not know what to say or do for a survivor.  While we want to be cautious, in general the majority of people do find ways to get back on their feet.  Most do not develop the disorder.

A youth worker can provide a safe place for exploration of the range of feelings related to such an event, while being on the lookout for a student who may need to be referred to a mental health professional.  Watch for signs that they are not coping effectively with what happened including withdrawal from others, increased risk taking behaviors, increased drinking or smoking, or grades dropping.

What do you think are the most effective practices of pastoral care that can help someone with PTS symptoms?

Giving kids a place to be honest about being angry, confused, and upset with God.  Having the chance to tell the story of their experiences as they are comfortable, but not pushing beyond what they are ready for.  Helping them to be thoughtful about decisions.  Helping them get practical needs met. Check out the Handbook for Psychological First Aid on the National Center for PTSD’s website for more suggestions.

We need to let them express whatever is going on in their minds in terms of their relationship with God.  Our pastoral tendency is to come in with some sort of answer, to help people not doubt anymore.  However, the most important first step is to be heard, even if what needs to be said are horrible thoughts toward God.  Let go of the need to be a theological educator and stay in the moment in a pastoral place with that person.  Acknowledge that it’s often hard to see God in the midst of those experiences.  We’ve got to be okay with that if we want to help an adolescent work through this in a healthy way.

For most people directly affected, grief is going to be one of the biggest issues.  Giving people a chance to get back to normal when they are ready to feel normal, and making space for them to take time to deal with the issues is really important.  Also helping kids get into some kind of routine assists them back to the regular developmental tasks they have to deal with as adolescents.  For high school seniors, this is a time to be considering steps for after graduation. It is very difficult (and often unwise) to make big decisions in the midst of a crisis. Parents and supportive adults can work carefully with students in this position to weigh the options and move forward at a pace that makes sense for that adolescent.

What about those of us who don’t feel like we’ve been directly affected by all of this in our communities?  Can you give us some thoughts on ways our students could be impacted that we might miss?

The sheer scale of what has recently happened means that people literally all over the country were affected.  Whether through watching the media, knowing someone who experienced loss, meeting families who relocate to your community, or volunteering to help in some way, everyone will encounter some level of exposure. Those who have their own histories of trauma – interpersonal (abuse) or property (house burning down, etc.) – are especially going to be at risk for experiencing negative reactions.  They may not directly “relive” the old traumas, but they might be more anxious or sensitive to the losses they see others experiencing.  The basic issue is making sure there is space for kids to process their experience of the disaster in whatever form it takes.  I would encourage students to be intentional about helping out in some way as a means of engaging both the situation and their own responses to it.

Also, because the media have been airing specials focusing on potential disasters, anyone can be left feeling unsafe.  There’s a balance of how we can learn from this tragedy and be motivated to prepare in some way based on what the disaster risks actually are.  Preparing can help reduce the level of anxiety.  This can be important both for trauma survivors and for anyone else feeling anxious.

From a psychological perspective, how do survivors of trauma get to a place of hope?  Is it ever too early to say “I’m going to make it through this; God is good”?

The first few weeks of a disaster are too early to say “God is good” to another person. Some survivors may be able to see God’s hand from the very beginning, but others may not. If we turn to someone in the midst of doubt and say, “God is going to get you through this,” we risk the possibility of the person feeling guilty or judged for not being able to hold onto that hope themselves.  I’ll never forget when I discovered Psalm 88.  It doesn’t end with professions of God’s faithfulness, but rather something like, “I’m going to die”.  There are moments in life where we do not see the hopeful side, and it seems impossible to hold on to God’s goodness.  We need to have space for both hope and despair in lament.  For many, it might take a long time to see God in the midst of what happened. For someone in a pastoral role, the most caring thing is to hear the doubts and not try to “fix” the person or convince him or her otherwise.

Would you say then that the capacity to lament, or complain to God and acknowledge injustice and pain, is valuable in the healing process from a psychological standpoint?

What I appreciate as a psychologist about lament is the truthfulness of needing to cry out to God.  God isn’t expecting us to buck up and get over it.  God wants to hear that we’re angry and hurt and scared.  It is a relationship – not just rising above reality and pretending it doesn’t exist.  Rather, God wants us to be real, and we have examples of that in scripture.

One of the things that can be helpful is to think about what it means to trust in God.  There are times when we are not able to trust God personally, but someone else in the community can trust God for us.  Their presence with us can bring hope.  A victim of trauma can experience that someone else in the community is holding hope for them.  I think one of the reasons God commands the recital of the Shema in Deuteronomy 6 is so the community would recite and recognize together how terrible their situation was, remember together how God rescued them through it, and claim that God will continue to be faithful.

Where can we go from here?

We always ask trauma survivors, “What would you do differently in the future?”  Survivors tend to regret choices made during a catastrophe, and get caught in self-blame rather than being able to move forward.  The goal is to take people with the experience and emotions they’re feeling and move them in a direction that can be fruitful.  Asking, ”what would you do differently?” allows that people can regret some choices, but that they can learn from it and move on.

We have a unique opportunity in the Christian community to look to our faith and cry out to God! We can let people ask the difficult questions of “where was God?” and “how can I trust Him?” without jumping in with an attempt to answer. We can carry hope in our hearts as we hear the stories of the hopeless, and we can offer a place of sanctuary that comes from simply listening with love.
 

Lament as a communal spiritual discipline for healing

Cynthia’s insights offer us helpful lenses as youth workers for viewing the psychological and spiritual implications of trauma.  What are some next steps in terms of helping your youth group as a whole process this before God?  Thinking back to Jeremiah, I’ve been reminded that right in the middle of his lament, and again at the end, there’s this unbelievable affirmation of the goodness, faithfulness, compassion, and great love of the Lord (see Lamentations 3:19-33, 5:19).  Is it possible that the only way to get to such a place of hope is to honestly name the pain and doubt first?  Our spiritual journey after traumatic experiences tends to move from, “Oh God, what happened?” to “How can I keep trusting this kind of God, and how do I even pray now?”  These are actually fantastic questions for a community to ask together in its worship and discipleship.

Theologian Walter Brueggemann challenges the Church to reconsider lament as a category of worship we’ve mostly forgotten or avoided.  Lament consists of crying out to God – even complaining to God – in the full expression of our pain and doubt.  Though this can be pretty messy, the book of Psalms actually contains a full 65 laments for us to see and sometimes use as models.  Brueggemann calls these psalms of disorientation.  He urges that our worship in community with others should not just focus on the cheerful aspects of life and faith, but must also consider the disturbingly incoherent and painful realities as well. 3 Brueggemann warns,

Where capacity to initiate lament is absent, one is left only with praise and doxology.  God then is omnipotent, always to be praised.  The believer is nothing, and can praise or accept guilt uncritically where life with God does not function properly.  The outcome is a “False Self,” bad faith that is based in fear and guilt and lived out as resentful or self-deceptive works of righteousness.  The absence of lament makes a religion of coercive obedience the only possibility. 4

Incorporating lament into your ministry takes careful thought, but does not have to be elaborate.  Perhaps you could start by taking time in your next worship service for a reading of Psalm 88, 80, 61, or 10.  Ask a couple of reflection questions like, “Is it okay to say these kinds of things to God?  How do you think it might deepen your relationship with Him?  Where could this kind of prayer go from here?”  Then read through the Psalm again and invite students to journal or draw their own continuing prayer for a few minutes.  Afterwards talk through their feelings of comfort or discomfort in approaching God that way.  Or, you might ask your small groups to look this month at a Psalm of lament together and contrast the attitude of despair and questioning with the confidence of Psalms like 27 or 46.

In response to traumatic experiences, it is critically important for a community of faith to offer space for this kind of response to God.  As youth workers, we may fear taking students to those places of doubt, anger, and disappointment with God.  However, failing to create an environment for authentic lament can result in spiritually and psychologically short-circuiting the necessary healing process.  This is a communal spiritual discipline we must not avoid.  Authentic trust in God may take a long time, and kids need faithful adults to walk that difficult road with them.  We in youth ministry have the opportunity to offer the hope of Christ and His re-orienting power to lives that have been plunged into trauma and disorientation.
 

Website Resources

There are a number of national organizations committed to the study and treatment of emotional trauma. The following websites post helpful resources:

  • The National Center for PTSD, http://www.ptsd.va.gov/ : Great handouts for care-providers and survivors alike. This website is FULL of information.
  • The International Society for Traumatic Stress Studies, www.istss.org : Resources for survivors and care-providers.
  • The National Child Traumatic Stress Network: www.nctsn.org : Important resources for kids and families. There is a disaster and terrorism branch and a specific portal for information on hurricane Katrina response.
  • The American Academy of Child and Adolescent Psychiatry, www.aacap.org More good handouts for kids and families.
  • Youth Specialties distributed a fantastic list of ideas for practical application in their September 7th “YS Update” email newsletter.  Several of these suggestions involve communal lament in worship.
     

Action Points:

  • Think about the specific students in your ministry who have been affected by traumatic experiences.  Do you recognize any of the signs of traumatic stress reactions?
  • How have you effectively used lament in worship as a way to process pain with students?  What are some ideas for incorporating lament into your youth ministry once a month for the next few months?
  • Do you think kids have enough space in their lives to process effectively and healthily traumatic events?  If not, why do you think that’s lacking?  What are some possible partner resource people or organizations in your community who can help create those spaces?
  • Consider using the attached training resource to discuss post-traumatic stress and lament with your leadership team. Click Here to download a FREE Leadership Team Training Resource (pdf)
Footnotes
  • 1. ^ Statistic from http://www.ncptsd.va.gov/facts/disasters/fs_range.html accessed 9/23/05. (1 instances in the document)
  • 2. ^ Lists adapted from the worksheet: “Reactions to a Major Disaster: A Fact Sheet for Survivors and Their Families” accessed from the National Center for PTSD website: http://www.ptsd.va.gov/ (1 instances in the document)
  • 3. ^ Walter Brueggemann, The Message of the Psalms: A theological commentary, (Augsburg Old Testament Studies, Minneapolis: Augsburg, 1984), 51. (1 instances in the document)
  • 4. ^ Walter Brueggemann, The Psalms and the Life of Faith, (ed. Patrick D. Miller.  Minneapolis: Augsburg Fortress),103-104. (1 instances in the document)