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Trauma- PTSD- Well Being
in the immigrant/ refugee
population
By Laura Coogan
Sept 2013

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Trauma
Trauma: Origin of the word in Greek means
wound
Psychological definition intentionally does not
allow us to determine whether a particular event
is traumatic; that is up to each survivor

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Trauma
• The traumatic experience is not in the
event but in the person who may have
difficulties coping with its impact.
• The negative event may eventually cause
overwhelming emotion and a feeling of
utter helplessness

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Stress
• Chosen events or circumstances can overwhelm
our system.
• Tend to be discharge over a short period of time
• Tend to have a clear meaning (I know why I am
so overwhelmed tired, etc)

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From normal reaction to PTSD
“An abnormal reaction to an abnormal
situation is normal behavior.”
Viktor E. Frankl, Man's Search for Meaning
PTSD occurs when the above “normal” reaction
does not extinguish and becomes dysfunctional.
People become “stuck” on the trauma

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'The Diagnostic and Statistical Manual of Mental
Disorders‘(DSM).
• PTSD is the only diagnostic category in the DSM
that is based on etiology. In order for a person to
be diagnosed with PTSD, there had to be a
traumatic event. Because most diagnoses are
descriptive and not explanatory, they focus on
symptoms or behaviors without a context: they
do not explain how or why a person may have
developed those behaviors.

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PTSD
Criteria: alterations in arousal and reactivity
Trauma-related alterations in arousal and
reactivity that began or worsened after the
traumatic event: (2 required)
• Irritable or aggressive behavior.
• Self-destructive or reckless behavior.
• Hypervigilance.
• Exaggerated startle response.
• Problems in concentration.
• Sleep disturbance.

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PTSD
With dissociative symptoms.
• There are situations in which people simply are unable to
affect the outcome of events: In the context of child
abuse, rape, or political torture, active resistance is likely
to provoke retaliation from the perpetrator. In such case,
"passive" coping is not maladaptive; sometimes "spacing
out" and disengaging can help better.
With delayed expression.
• Full diagnosis is not met until at least 6 months after the
trauma(s), although onset of symptoms may occur
immediately.

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PTSD
Some survivors engage in high-risk
behaviors (present) and activities as
unconscious re-enactments of the
hyperarousal and adrenaline –infused
action during the traumatic events (past)

10. PTSD and Psychosis
Potential for psychotic symptoms may occur as a
comorbidity of chronic PTSD.
These symptoms may include illusions (misinterpretations),
hallucinations (hearing, seeing, smelling what is not there) ,
and dissociative flashback episodes. If delusions (incredible
beliefs) do occur, they are primarily paranoid or
persecutory in nature. The lack of complex hallucinations,
delusions, or formal thought disorder helps differentiate
PTSD with psychotic symptoms from schizophrenia or
schizoaffective disorder (loss of reality testing).
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11. Risk Factors for PTSD
• Previous psychiatric illness
• Previous exposure to trauma (especially in
childhood)
• Duration and magnitude of exposure to
stressors.
• Perception of grotesque imagery (especially of
human remains or children).
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Risk factor for PTSD
Most severe if the negative event is:
•Human caused
•Repeated
•Unpredictable
•Multifaceted
•Sadistic
•Undergone in childhood
•And perpetrated by a caregiver

13. PTSD summary
• Stressors trigger massive reactions of fears,
helplessness, horror.
• Dissociation: emotional numbing, detachment,
reduce environmental awareness, amnesia.
• Intrusiveness: dreams, flash backs, uninvited
recollection. Avoidant behavior
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14. contin,
• Avoidance: decreased interest in the present, feeling of
detachment (to provide some safety from the threat of
the trauma repetition and the pain attached to it and a
sense of extreme vulnerability)
• Hyperarousal, insomnia, irritability, poor concentration,
hypervigilance, exaggerated startle response.
• Impairment of social functioning: dysfunctional social
behaviours.
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15. Most common sequeals of
PTSD
Tendency to
•Affect dysregulation: intense emotional reactions
•Dissociative problems: learning difficulties,
memory disturbances
•Depression
•Difficulty with trust and intimacy
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Well Being/Self-Actualization
“The basic needs of humans must be met (e.g.
food, shelter, warmth, security, sense of
belongingness etc.) before a person can achieve
self-actualization - the need to be fully alive and to
find meaning in life”
Abraham Maslow
For successful treatment we need to work with an
interdisciplinary team in a cooperative manner.

17. Spontaneous resources to heal
PTSD (religious belief)
• Church attendance is associated with better health due
to social support, increase of social network that enable
a person to have a sense of belonging (vs. isolation).
• “An interactive relationship with God, cultivated through
imagination, in prayers may contribute to good health”
Marie Luhrman
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18. Differentiating psychotic states from
religious experiences
• Details exceed conventional expressions of
belief.
• The belief takes over the whole presentation of
the client narrative
• Onset of the beliefs marks a change in the
client’s life with a deterioration of social skills.
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19. Healing PTSD
(Psychotherapy)
• The therapist may evoke the transitional object
(D.W.Winnicot) by acknowledging the client’s
pain and responding with care and kindness.
• Supports the person to practice self care and
exploratory curiosity as opposed to self criticism
which increases a sense of inadequacy.
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20. Integration between therapeutic generic
approaches to specific culture
• Sharing frame of reference (DBT, CBT, SRT,
Gestalt, psychodynamic, psychopharmacology,
Narrative therapy, group therapy)
• Asking for frame of reference: what is your
healing style, approach, theory, practice?
• Consult with family members or friends as what
is their view of the problem/ solution
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21. Integration between therapeutic generic
approach to specific culture
• Clinical urgency (reduce hyperarousal, anxiety-
like symptoms, sleepiness, lack of
concentration, dissociation)
• Negotiation of priorities
• Person’s preferences
• Attention to history and social context
• Inclusion of language as an essential element of
identity
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Healing PTSD (tools)
• Work in the present moment: What are you
noticing vs. what did you notice.
• Trauma is in the nervous system, not the event
so renegotiation is taking place in the here and
now: What do you notice in your body as you
have that thought/memory?
• Use language that keeps the clients in the here
and now.

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Healing PTSD (core goals)
• Healing is an invitation for grieving.
(different losses e.g. idealisms)
• Healing is an invitation to accept what it was and what it
is (discrepancy between achievement and expectation).
• Re-invention of self.
• Healing leads to making meaning of the traumatic
experience.

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Re-invention of self
• “Do not judge me by my successes, judge
me by how many times I fell down and got
back up again.”
― Nelson Mandela

25. Conclusion
“Life is never made unbearable by
circumstances, but only by lack of
meaning and purpose.”
― Viktor E. Frankl
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Interesting…
• “In my country we go to prison first and
then become President. ”
― Nelson Mandela

27. To watch!
Mr. Happy Man - Johnny Barnes
http://youtu.be/v_EX5NzqNXc
Kung Fu 1972/ season 1-episode4)
http://youtu.be/IKH4nY4WlFY
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