ONLINE EDITION FRIDAY NOVEMBER 23, 2001

News

"You have all been traumatized," said Joyce Braak, M.D. to members and guests of Temple Emanuel's Sisterhood recently. And from that point, she launched into a mesmerizing speech that wove her experiences as a trauma expert who has intervened in scenes of horror around the world, along with a hopeful message of how people can transcend trauma rather than become imprisoned by it.

Dr. Braak, a surgeon and a psychiatrist, likens our stress and subsequent reactions after Sept. 11 to those of people who have lived through captivity rather than people who have survived a trauma that has a beginning, a middle and an end, such as living through a hurricane or an earthquake. The events of Sept. 11 were "horrific, sudden, inescapable and incomprehensible ... and they grew in horror," she said. It is a conflagration that is open-ended and continues to burst into flame both literally and figuratively, adding to the raw distress we feel.

She related the story of Bob Simon, international correspondent for CBS News, who, along with three other news crew members, was held hostage in Iraq in 1991 for 40 days and who recounted that the horror of the experience of imprisonment, privation and unpredictability was compounded by hearing his fellow captives, being tortured and being unable to do anything to help them. It is this sense of helplessness that has the potential to break one's spirit. She says that in all of her interviews with people who have endured captivity even the smallest grain of hope sustained them and kept them sane.

When Mr. Simon was released, plans were made for a ticker tape parade, but Dr. Braak urged the authorities to tread carefully and get Mr. Simon's permission before doing anything of the kind. In fact, he did not want the spotlight, but indeed wanted to be with his family and have some privacy.

So while being traumatized by such an unimaginable event as occurred on Sept. 11 is normal, there are adaptive and maladaptive ways of handling the aftermath, according to Dr. Braak. Feelings of numbness can rob one of the simple pleasurable moments in life, while avoidance of anything associated with the event, such as flying, going into a skyscraper or visiting the city, can imprison one. Flashbacks, by the way, are not like having memories. Flashbacks are intrusive, reliving experiences, in which involuntary reactions such as sweating and an increased heart rate occur along with disruptions of cognitive functioning. This loss of control is frightening, paralyzing, and dashes one's sense of sanity.

Unexamined, untended trauma can lead to behaviors that can further rob one of joy, jobs and relationships. These behaviors may involve drug and/or alcohol abuse, unbridled risk-taking, withdrawal and in extreme cases, when a person exerts one last piece of power, suicide. Dr. Braak believes that the group debriefing strategy used for the rescue workers after Sept. 11 was inadequate, as it takes a "one-size fits all" kind of approach. As a result some firefighters, EMS workers and police worked frantically at the pile, long after hope for finding survivors had faded. She says that the un-relieved exposure to and the inhumane demands of the pile were not in the best interests of the surviving workers and their families.

More adaptive behaviors include connecting to people, redefining one's sense of mission, taking action to make the world a little better, re-prioritized time for family and friends, and acting in all ways that take back one's personal power that is swept away during catastrophic events. Rather than saying, "I'll never fly again," Dr. Braak's advice is to reframe the situation by saying, "I will fly again when I feel ready."

To be active or passive can make a huge difference in one's ability to recapture feelings of vitality. One's perception of time is significantly altered based on the active or passive pivot. After the last serious earthquake in San Francisco, Dr. Braak had interviewed people caught in different circumstances. She found that when people were active in fleeing danger, their sense of the time frame of the quake was very shortened, while people who were trapped and awaiting rescue thought that the length of time of the tremor was much longer than it was in fact.

Time distortions can play a role in survivor guilt. Sometimes a person can get stuck in irrational and unrealistic expectations of themselves. Dr. Braak was counseling a military commander whose troops were ambushed resulting in many casualties. He recounted to her all the things he could and should have done to save the men. But when she questioned him about how much time each action would have taken to accomplish, the total time was tallied in hours, while the attack itself was over in a few minutes.

With trauma, every assumption about the workings of the world is shattered and one's capacity to trust and ability to make judgments is challenged. It is a struggle to accept a changed world. At the onset of the crucible, during the period of denial, many people hang on to the wish to make time go back to before the defining date of Sept. 11, 2001. But with the passage of time and the renewed hope and determination to live life, people have the potential to be resilient and adapt to the new reality.

Dr. Braak warns against allowing oneself to drown in the "Ain't it awful" mode of helpless, hopeless thinking. She urges everyone to take every opportunity to see the choices still present in life. And she says, "Laughter can save your life!" In her view, it is not patriotic to give up that great American pastime of "poking fun at politicians.'' Just the opposite. More than ever, this is the time to embrace and celebrate all of our freedoms. And humor is a very stabilizing force.

But she also cautions about judging another person's degree of trauma, stating that each person processes painful events individually based on past traumas, associated feelings and personality type. She advises that we should allow a traumatized person to tell his or her story without interrupting; we should listen more closely to each other.

Since Dr. Braak has spent a great deal of time in Afghanistan, along with other Mideastern hotspots, a question was directed to her about understanding the mentality of the terrorists. She stated quite flatly that their minds work differently from ours. She said, "These people (the terrorists) have different values and do not value you or your life. You can't engage them, reach them, negotiate or compromise with them ... they are alien and we must accept that and pay attention to studying them as you would a dangerous and exotic animal."

She closed with some sound bites that pack some important messages: Avoid avoidance. Plan. Defiance is a good thing. (Move over, Martha Stewart!) Look for laughter. Savor the moment. Don't wait to take pleasure. Let yourself risk and feel. Be glad, be sad, be mad, be human. Be grateful you've got feelings. Sing in the shower and listen to the words, "tho' your dreams be tossed and blown." *

Dr. Braak is currently president of the Institute for Research on Women's Health; director of Human Rights and Women's Health Project; Gonvener, Task Force on Health, United Nations NGO Committee on the Status of Women and Chairman, International and Cultural Committee, and Association of Traumatic Stress Specialists to name a few of her duties.

*You'll Never Walk Alone by Rodgers and Hammerstein from Carousel.

(Editor's Note: As we go to press, we have been in touch with Dr. Braak by e-mail. She is working now to ensure that Afghan women are included fully in the future of Afghanistan as they comprise 55 percent of the population. Dr. Braak says, "More than protection, Afghan women need participation." As we had thanked her on a personal level for her remarks on the day she visited Great Neck, she wrote in return, "Enjoy your family and your freedom. I am so pleased to have contributed a little to it. Remember, any human being can be injured, even killed. The goal is to remain unconquered, unintimidated, free." These are our wishes for you, our readers, as we enter a season of thanksgiving.)