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Trauma
6 min read

What to do when life interupts

Mental Health Week acknowledges the many traumas and interruptions in life, notes clinical psychologist Roger Bretherton - who analyses how we might respond to them.
A blurred exposure of a person under a hood turning their head to the side.
Photo by Ehimetalor Akhere Unuabona on Unsplash.

For over a decade I worked, as a Clinical Psychologist in a service treating people who had suffered trauma. I clocked just under ten thousand hours of clinical contact with people who had been through the worst situations imaginable. One thing I learned during that time is that trauma often occurs to us as an interruption.  

Most of us live our lives to some script, a set of assumptions of how we think things should be, our expectations of what is about to happen next - and trauma shatters those assumptions. Over and over again, people who had been through trauma told me how their view of the world had been violated. The narrative that defined their life, the story they thought they were in, changed genre unexpectedly. The romcom became a horror movie; the adventure became a hideous farce. The story called walking home at night turned into another one called being mugged. Driving to the supermarket became, having a crash. A day out at the beach, became delivering CPR. All of them illustrate how trauma sends an earthquake through our view of what we thought our lives were and, if we survive, leaves us in the rubble picking up the pieces. 

In one fell swoop it gave an insight into why it is that trauma occurs to us, not just as an event or a set of events, but as an interruption to our whole sense of reality. 

Back in the early days of researching AI systems one study illustrated the catastrophic effect that even the mildest contradiction of our expectations can have on our entire view of reality.  

In the quaint old days, when Chat GPT was a nightmare for a future generation, an expert system was developed with one simple aim in mind: to identify birds. Such a simple task. The specifications of various species of animal were entered and, by applying a broad array of criteria, the system would indicate whether the said species was a bird (or not). But not all its criteria were accurate. One of the rules of thumb the system developed was: ‘all birds fly’. Which worked fine until it was required to categorize a penguin. In the first attempt it followed its own rules and concluded that penguins were not birds. But when forced by the programmers to categorize a penguin as a bird, the system went into meltdown attempting to reconcile the contradiction with its own criteria. To resolve the anomaly of the penguin being flightless and yet still being a bird, it concluded that no birds could fly. In one fell swoop it gave an insight into why it is that trauma occurs to us, not just as an event or a set of events, but as an interruption to our whole sense of reality.  

The nightmares, the flashbacks, the apprehension, irritation and sense of foreboding, the numbing and the terror. All of these are an attempt to make sense of a world that no longer makes sense. Of course, it would be heartless to suggest that the agony of trauma is little more than a glitch in our information processing. Reducing it to a bug in our programming would conveniently trivialise the horrors that can befall human beings. I have no desire to sanitise or diminish the horrors that can haunt us, but trauma is at least this - a hiatus, a shock, an interruption.  

The agony that intensifies our fears, depressions and compulsions is often the torturous comparison between who we thought we were and who we have become. 

It is not just trauma that interrupts us. Life specialises in throwing wildcards and anomalies into our path. Just when everything seems to be going swimmingly, when we seem to know what we are doing, when the future seems mapped out before us, the unexpected and the unwelcome occurs. The best way to make God laugh, goes the saying, is to hand Him our five-year plan. I’m not sure I have ever spoken to anyone with insight into their own psychological distress who doesn’t to some extent experience their pain as an interruption. The agony that intensifies our fears, depressions and compulsions is often the torturous comparison between who we thought we were and who we have become. Our imaginary ideal self, the person we thought we would be, waltzes away into a future of freedom, light and joy, and leaves us behind in doubt and uncertainty. 

Mental Health Week could in some ways be viewed as an acknowledgement of the interruptions in life. I can only imagine what has interrupted you. I can only hazard a guess at what it is or was that derailed the smooth trajectory of your predicted life. Was it bereavement or aging, sickness or betrayal, disappointment or assault, redundancy or financial ruin? Whatever it was, it may not be reversible. This is one of the reasons for the burgeoning of mindfulness practices in mental health treatment. We don’t just need a technology of change to help us get better, we equally need a technology of acceptance to be able to live with what we cannot change.  

I’ve lost the ability to firmly believe that the future can be planned out, that the straight line into the next few years cannot be shattered without warning at any moment. 

For me, the lockdown was an interruption from which I have never really recovered. I hesitate to say this because I worry I might be the only person who feels this way. I know it’s all supposed to be over. We’re back to work and acting like the world is rational and predictable again. But the great reset just doesn’t work for me. My mind is ready to go, but my heart just hasn’t got the memo. I’ve lost the ability to firmly believe that the future can be planned out, that the straight line into the next few years cannot be shattered without warning at any moment. There is a hesitancy in all my plans, an uncertainty in my ambitions. The solid arrow of time is dotted, if not broken. Experts in trauma call it the sense of a foreshortened future. The disruption of our capacity to self-transcend, to bridge ourselves towards the person we may become. Our once lucid image of a better self flickers and grows dim, no longer compelling or believable.   

And if that’s not confession enough, I have another one. One that makes me sound like a rehab resident in a young adult drama. In the midst of the lockdown craziness, I was forced to slowly and reluctantly uncover a gift. Like a treasure buried in a field, or a priceless pearl concealed among the worthless tat of a car boot sale. Something so crashingly obvious and cringeworthily twee that I can hardly bear to put it in writing. Many of my plans and ambitions were imaginary, just plain illusion. I was no happier achieving them than I was pursuing them. But I started to glimpse, that if I could overcome the grief of losing them, I would be better off without them. If I could put words to it, I would say that I came to a deeper appreciation of grace – iit’s not a bad thing just to be. We can be so busy trying to become something that we fail to notice that we were before we even began. This has now become a daily contemplative practice for me. I call it being present to The Presence in the present. Somehow, I came to a deep inner settlement that I no longer needed to work to justify my existence, but could work out of a present moment in which my existence was already justified. I came to accept acceptance.

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Care
Culture
Mental Health
Trauma
5 min read

Stillness is not always peace: how wellness and illness intertwine in silence

Stillness invites clinical insight—and a deeper kind of presence

Helen is a registered nurse and freelance writer, writing for audiences ranging from the general public to practitioners and scientists.

A seated Celine Dion, leans forward, head to the side, holding a mic.
Celine Dion, stiff-person syndrome sufferer.
Celine Dion.

The Global Wellness Institute defines wellness as the active pursuit of activities, choices and lifestyles that lead to a state of holistic health. It includes rest and rejuvenation, through mindfulness, meditation and sleep. As a care home nurse, I am intrigued by the subject of stillness – for patient and nurse - in the pursuit of wellness, and as a sign of illness.  

There’s a lot of stillness in illness - from the dense paralysis that can follow stroke or spinal cord injury, to the subtle weakness or stiffness in an arm that might signal the onset of motor neurone disease. Over half of people with Parkinson’s experience ‘freezing’, feeling as if their feet are momentarily glued to the ground. Freezing is also a feature of stiff-person syndrome – the auto-immune neurological condition powerfully documented by Celine Dion in her film I Am. In so-called stone-man syndrome, muscle tissue is replaced by bone, an immobile ‘second skeleton’. 

The stillest still is seen in death itself. I’ve stood still with spouses and sons as their loved ones breathe their last. Alone, I’ve watched the hush between heartbeats until there exists only stillness beside sorrow. It’s a stillness like no other, when breath becomes still air, and the only movement is through a window opened to let air in, and souls out, in time-honoured nursing tradition. 

In memory of babies born still, a public education and awareness campaign has been launched in the US. “Stillness is an illness” calls for families and healthcare providers to take seriously altered foetal movement in pregnancy, which is reported by 50 per cent of mothers who experience stillbirth. Stillbirth is a tragedy insufficiently addressed in global agendas, policies, and funded programmes, according to the World Health Organization. Mothers in sub-Saharan Africa and Southern Asia are at highest risk, with nearly 1.5 million stillbirths in these regions in 2021. 

Sometimes stillness manifests in more muted ways. When dementia robs the recall of person, place and time, residents no longer lift their head in response to their name, nor appear at their chosen place at the breakfast table in the morning. Television presenter Fiona Phillips describes the late stages of dementia for her mother, when she “spent whole chunks of time just sitting and staring ahead, only able to give out a series of sounds.” In care home nursing, I have brought stillness to an agitated mind. Therapeutic touch has relieved tension; creative activities have reduced restless pacing up and down. Music, movement, and medication can also calm a troubled mind. 

In the further pursuit of patient wellness, the nurse may need to be still. The “CAREFUL” observation tool has been developed in nursing homes, in which the nurse sits still and discreetly watches a resident for a period of time, assessing their activities and interactions, working out what brings wellbeing, or ill-being, for that individual; residents in this case being our best teachers. Other times in dementia care, the nurse is still as they patiently wait for a resident to explore, enquiring into self-made mysteries solvable only by themselves, examining everything from door handles to another resident’s buttons; or to slowly finish a meal, their swallow also affected by the disease.  

Punctuating any frantic nursing shift are other moments of necessary stillness as the nurse performs intricate procedures, carefully inserting catheters, delicately taking blood from fragile veins, or applying prolonged pressure to stem bleeding caused by a catheter during cardiac stenting. In the operating theatre, the scrub nurse stands still awaiting a surgeon’s call; the “honor walk” or walk of respect is a ceremonial procession in which healthcare staff line the corridor, in silent tribute, as a brain-dead patient is taken to theatre for organ donation. 

There’s a different stillness sought in nursing, and elsewhere, which runs very deep. Described by missionary and author Elisabeth Elliot as a “perfect stillness…a great gift”, it is, in her words, “not superficial, a mere absence of fidgeting or talking.  It is a deliberate and quiet attentiveness—receptive, alert, ready”. It’s an expectant stillness in which we “put ourselves firmly and determinedly in God’s presence, saying ‘I’m here, Lord.  I’m listening’.” Writing for the Christian Medical Fellowship, nurse Sherin describes such a seeking during a stressful shift. “Overwhelmed, I stepped away to find a quiet place. I ended up in a washroom. It wasn’t ideal, but there I cried out to God, asking for courage, peace, patience, and above all, love for that patient.” And her prayer was answered. “That, to me, was the quiet, powerful presence of Christ,” she writes. 

Her role model was Jesus himself who often stepped away to be still, to seek spiritual sustenance. Just before he fed the five thousand, Jesus said to his tired and hungry disciples, “Come with me by yourselves to a quiet place and get some rest.” When grieving the execution of John the Baptist, he withdrew by boat privately to a solitary place; and in the hours before his arrest, Jesus withdrew about a stone’s throw from his disciples, knelt down and prayed. An angel from heaven appeared to him, and strengthened him. We too are invited, in the book of Psalms, to “Be still and know God” when hard pressed and weary. Here, the words “be still” derive from the Hebrew rapha which means “to be weak, to let go, to release”, or simply to surrender. It’s a theme repeated in many of the great Christian hymns, hinting at an expectant, sustaining stillness, invoking God’s promise of His presence in that stillness. Little-known hymnwriter Katharina von Schlegel, writing in the eighteenth century, captures it perfectly. 

Be still, my soul! the Lord is on your side; 
Bear patiently the cross of grief or pain; 
Leave to your God to order and provide; 
In ev'ry change he faithful will remain. 
Be still, my soul! your best, your heav’nly friend 
Thru' thorny ways leads to a joyful end. 

I’ve sought this stillness, and it’s brought me wellness. It’s the reason why, despite some difficult days, I am a nurse. Still. 

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