Column
Change
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.

Article
Ageing
Care
Change
5 min read

Delicate, fragile, frail: how we cope when we age

The insights and analogies that help.

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

An old woman wearing a shawl looks pensive.
Valentin Balan on Unsplash.

“Who could dissect a portion of the human frame without marvelling at its delicacy, and trembling at its frailty?” mused preacher Charles Spurgeon in the nineteenth century. Songwriters, artists, authors and surgeons alike are fascinated by frailty. Within, beneath and beyond that fragile frame though, could there be a deeper reality, waiting to arise – and endure? 

Fragile Lives is the ‘heart-stopping memoir’, operation by operation, of heart surgeon Professor Stephen Westaby. “The finest of margins,” he writes, “separates life from death, triumph from defeat, hope from despair – a few more dead muscle cells, a fraction more lactic acid in the blood, a little extra swelling of the brain. Grim Reaper perches on every surgeon’s shoulder.” 

To what shall we compare this fragility of frame? - which means we can shatter sudden as glass, our “breath becoming air” in the blink of an eye? (Paul Kalanithi, a young neurosurgeon, called his memoir When Breath Becomes Air as he fought his own battle with cancer). A snowflake? A spider’s web? A butterfly wing? In Dutch still life paintings, the transience of life is variously depicted in dry, fallen withering petals, rotting fruit, and a glass vessel, like a vase. At some funeral services, it is said that we are made from dust, and to dust we shall return. Elsewhere in the Bible, we are likened to a mist that appears for a little while and then vanishes, or to a flower that withers away, a fleeting shadow that does not endure. Our days are a mere handbreadth, our life but a breath, writes one Bible songwriter. 

Medics talk more commonly of frailty than fragility – and it’s not just a byword for old age. According to the British Geriatrics Society, not all old people live with frailty; not all people living with frailty are old, though age is a recognised risk factor, with nearly 40 per cent of adults aged 85-90 being frail. Described as a vulnerability to external stressors which can result in sudden marked deterioration in function, frailty might feature as a combination of falls, immobility, delirium, incontinence, and increased side effects of medications, suggesting the body is struggling to cope. “A minor infection or minor surgery results in a striking and disproportionate change in health state – from independent to dependent, mobile to immobile, or lucid to delirious,” writes a team of doctors in The Lancet

Frailty is a sign of advanced biological rather than chronological age. Often, it’s an unwelcome term, with consultant physician Patricia Cantley noting that, “from a patient or relative’s point of view, the word frailty seems to be at best somewhat vague and at worst, derogatory and demotivating”. She prefers to talk in terms of paper boats. Picturing young healthy patients as little tugboats of wood and steel, built to withstand storms, she likens the frail patient’s clinical situation to a paper boat, which can sail the sunny seas, but is soon buffeted and may be brought down by ‘medical winds’. 

Encompassing also psychological and cognitive symptoms alongside the physical, frailty is not a fixed state, nor is decline in mind and body inevitable once frailty begins. Seen increasingly as a dynamic spectrum, reversal of frailty is sometimes possible; the paper boat being, to a degree, storm proofed and made to chart a different course. According to Dr John Travers, professor of public health at Trinity College, Dublin, twenty minutes of daily exercise can reverse physical frailty and build resilience in over 65-year-olds, while others suggest that movement based mind-body therapies such as tai-chi and yoga can strengthen both mind and body. Could there also be something of a spiritual strengthening in the frail patient? As the body decays and declines, could the soul, the spiritual self, enlarge, emerge and ultimately endure as life ebbs away? This was certainly the sentiment of Paul, one of the early church leaders, in the Bible, who, after much suffering, wrote: “Therefore we do not lose heart. Though outwardly we are wasting away, yet inwardly we are being renewed day by day…we fix our eyes not on what is seen, but on what is unseen. For what is seen is temporary, but what is unseen is eternal.” 

Her late Majesty Queen Elizabeth II was seen on our television screens to diminish physically in her last days, her purple hands, tiny frame and walking cane causing concern among viewers. She was, at her funeral, described simply as “our sister Elizabeth”, her small coffin dwarfed by pageantry and a crowd of 2,000 including presidents and kings. And yet, the former Moderator of the Church of Scotland has revealed that she talked much of her Christian faith in her dying days, while her funeral was an explosion of scripture, hymns and sermons that expressed the strength of her personal faith. “It was her way of eloquently, beautifully and powerfully speaking to me and 4.1 billion other people of her Christian faith,” writes Pastor Skip Heitzig. For me, the funeral brought to mind the tides (continuing with the theme of the sea). As the tide recedes, the waters move away from the shore, in what is known as an ebb current. As the tide rises, water moves toward the shore in a flood current. As our Queen’s life ebbed away physically, her spiritual self arose, roaring like a mighty flood. Ocean motion, in currents, waves and tides, is driven by the sun, moon and the planets. Our late Queen also looked upwards, to her God, for spiritual succour that would turn life’s ebb to a soul-flood.  

Hymnwriter Timothy Dudley-Smith sought a similar exchange, from the physical to the spiritual, the mortal to the immortal, in yet more words about boats, in his hymn “My boat so small”, based on the Breton Fisherman’s Prayer. 

“Adrift when strength and courage fail, O Spirit, breathe to fill my sail” 

And, happily, he trusts a safe voyage, finishing with - “My voyage done, all trouble past, to haven bring my soul at last.” 

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