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.

Roger is Associate Professor of Psychology, at the University of Lincoln. He is a UK accredited Clinical Psychologist.

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.

Interview
Change
Gaza
Israel
Middle East
S&U interviews
Suffering
War & peace
11 min read

Eye witness: life and death in Gaza’s European Hospital

Returning plastic surgeon Tim Goodacre reports on the struggles, the despair and the dignity of the people and the medics of Gaza during their long nightmare.

Graham is the Director of the Centre for Cultural Witness and a former Bishop of Kensington.

Medical staff stand beside a bed in which a man lies with an amputated leg.
Medics confer about a patient in Gaza's European Hospital.
Tim Goodacre

Tim Goodacre is a vastly experienced plastic surgeon who recently spent two weeks in a hospital in Khan Younis treating the extensive injuries of the people of Gaza. I caught up with him to ask about his experience there.  

Graham: Let me start by asking what was it like getting into Gaza? What was the process and how difficult was it to actually get in in the first place? 

Tim: We went in as an emergency medical team under the under the auspices of the World Health Organisation, which is coordinated with UN OCHR. It was easy obviously to get to Cairo. Then we joined a convoy, a group of cars convening in the small hours of the morning in Cairo and then being escorted across the Sinai desert. We got to the border in time for dusk. What was staggering at that stage was seeing the number of lorries lined up, waiting on the Egyptian side to get in. They were two deep on one side, one deep on the other with a thin passageway through which we could drive through for mile after mile after mile of these lorries. 

Was this humanitarian aid sent from other nations? 

Absolutely. It was aid labelled from different countries or agencies. Crossing Rafah the next morning was all pretty haphazard and chaotic, but we met our driver on the other side. We then had to travel to Khan Yunis on the coast road because it was the safest part of the south Gaza strip. We went through a route called the Philadelphia Road, which is a gap between the two borders. As we drove along, we immediately were jumped on by some young lads who had put razor wire across the road. We picked up two of them who hung onto the car each side, with our window s firmly shut. As we sped along, they were our ‘protectors’, taking a pitiful sum to ensure that we would not be stopped at further razor wire and our vehicle plundered. It was our first experience of the lawlessness that's inherent at the moment in Gaza. 

All along that side of the road there were people putting up new tents after a recent further mass displacement, as far as the eye could see. It made a huge impact on me - the devastating plight of the people who were there. It looked like those pictures of Glastonbury or Woodstock, where as far as you could see, the rolling fields or sand dunes or whatever were totally covered in makeshift dwellings. It was pretty cold and windy. And subsequently, while we were there, it rained an awful lot and your heart just went out to these people.  

So these were people living in tents and temporary shelters? 

 Well, not really. They're barely tents. They're just finding flimsy bits of wood, putting them up and nailing them together. And these are not just the very poorest of the poor. This is everybody. Many of them were people from very well-to-do houses whose families have been displaced. I've worked in many parts of the world where there's poverty, but I’ve never seen so many people displaced.  

One of the things that's remarkable however is the relative cleanliness, the desire to maintain dignity in the most appalling circumstances. But a young lad who’s now a young doctor (who I have worked with for a decade now) came to see me and he was the most dejected person I've ever met. He said to me ‘they've taken away my dignity’. The abject pain in his face was something that I won't forget.  

You’ve been to Gaza many times before. What was different about this time? And you've seen it in the aftermath of previous wars and conflicts. What was what was particularly different this time? 

 It's utterly different – it’s the displaced population with nowhere to go and seeking shelter. When I first went in 2014 after Operation Protective Edge, I was taken to a huge neighbourhood of northeast Gaza, which had been flattened and at the time the impact on me was extraordinary. When I’ve visited subsequently over the last decade, they will show you this bombed out building and that flattened area, but I've never seen such vast numbers of displaced people. On the second day we moved into the European Gaza Hospital (EGH), which is where we were going to stay for the two weeks we were there. Inching slowly along amidst endless hordes of people walking around, seeing the dejection, despair, the hopelessness with nowhere to go - this for me is what defines this whole episode and makes it very different from others. This is in no way a diminution of other conflicts and human tragedies, but when there was bombing in Baghdad or in Kiev and Ukraine, people might go into underground shelters - there are places they can perhaps go to escape. Even in massacres such as in Darfur or Congo, there are places to run to. There is nothing like that in Gaza. 

Was there a pattern to the kind of medical emergencies and wounds that you were having to deal with? 

 The vast majority of injuries were the impact of high explosives, so we naturally saw quite a lot of burns, although the majority of severe burns alone were being managed by the Red Cross team also at EGH. Some of them were people who had been crushed and pulled out of buildings which had collapsed. But that was that was the minority. The majority of our cases were direct results of bomb blasts. Every time you hear a bomb, somebody is being killed, yet many others are caught on the fringe of that. Shrapnel travels at astronomical speeds and hits people in in a completely random way. These injuries are devastating. There were scores of people coming in with limbs missing. Seeing somebody with a leg off at the thigh, a leg off below the knee, an arm ripped off was all too common. It was hard to take in - you have to become somewhat immune to the backstory behind each dreadful injury, and concentrate on the carnage in front of you, to be able to deal with the constant onslaught of cases. 

How were the medics coping with it? You were there for two weeks. They are there for months, presumably on end? 

 I think it's incredibly important that we don't focus on the visiting medics. I usually peeled off at about 9pm or so in the evening - I had to go to bed and had to have a rest, but there were people trying to work through the night. What I want to focus on is the local people, particularly a young colleague, Ahmed, who was 36 years-old. He was statesmanlike in his ability to pull things together. His family are actually mostly in Dublin as they've got Irish passports. I cannot tell you how much admiration I have for that young Gazan man who shared his room with me.  

He has been managing to create a team who work alongside him, since many of the staff who had worked at the hospital before (some of whom we had trained over several years in limb reconstruction) were not there. That is because they might not be alive, or having to support their displaced families, or simply are afraid to travel in daily to the hospital, or whatever. It is a huge demand on individual doctors to leave a family group (who invariably try to stay together, so that if they are bombed, they all die together and do not have to be a sole survivor.) to then work away from such possible loss of all their family members. It's an incredible sacrifice to be working in medical care when your family are all huddled together in a place where they may all lose their life, and that gets to them in the end.  

The orthopaedic side is almost on its knees. Most of the system in the hospital is utterly on its knees. There were early years medical students who had been taught quickly how to manage wounds and to skin graft. They haven't got any pay, but some people have given a little money to my colleague’s account to try and give them some support. There were IT students and all sorts of others pulling together. How people can work in in such adversity and make things happen is quite a testament to the to the strength of humanity.  

It all begins to play on your mind, and you start thinking is there another one coming? And you get no warning when the attacks are unleashed. 

What was it like living under the bombardment, which was presumably pretty constant during your time there? 

There may have been the odd period of four or five hours when there was no sound of close bombardment at all, although during that time there was probably small arms fire going on somewhere. But otherwise, it was relentless. One became somewhat used to the bombs in the distance, but when they're close by… Every time one of these bombs goes off, there are people dying. And that really that played on your mind. So huge numbers were seeking shelter anywhere in the vicinity of the hospital. If you can imagine a hospital corridor where every route is full of makeshift shelters, and you just go up around a stairwell and on the corner of each stair, there will be a family which will be hanging drapes up, trying to find some sort of privacy and dignity among the utter destitution.  

I found it very difficult to sleep during those times. The hospital is in a quadrant, a square. On one corner there was a supermarket which latterly was hit by an F16 delivered weapon. You could hear the sound of the rocket go off alongside the scream of the low flying fighter jet, and the whole building shook. There's also the incessant sound of drones. It all begins to play on your mind, and you start thinking is there another one coming? And you get no warning when the attacks are unleashed.  

It made me realise what soldiers undergo when they get what used to be called shell shock. There, even if you're not injured yourself, this constant shocking damage gets to you. I knew we had the knowledge that after a short time, we would be getting out - but it made me realise how tough Ahmed and others working there have to be. It will be having a devastating impact on the population, and for a nation.  

I imagine the psychological effects of that are going to last for a long time in the lives of these people. You don't get over that quickly. If you live with that level of tension, thinking any moment now, I could die, that must stay with you and the marks of that stay for a long time. 

I'm sure that's true. I'm not an expert in PTSD and things like that. Ahmed is a Muslim and said to me more than once that when you believe in an afterlife, you believe that your time will come at some point, and you accept that. We don't know when it is or where it is, but it will come. I have frequently wondered whether any of the fighter jet pilots have ever experienced themselves what it’s like to be underneath the impact of one of their weapons? Having felt somewhat what it is like to be on the other side of such an onslaught, I do wonder whether very many of those involved in ordering conflict really have any kind of understanding of what devastation feels like, when there is nowhere to run? I fear for what this conflict does to the humanity of both sides. 

I genuinely don't feel brave, I don't. I'm not the kind of person who sees lights in the sky, but I know it was God’s calling to go there. It was simply the right thing, 

Did you see any sign of hope or anything that gave you a sense of the way out of this? 

 The sense of hope is within the people who are there. There are many people who say they still really don't want to leave. They feel this passionately. It's their land. They do want to see a new Gaza. I tried to be somebody who lifted spirits. Communities can be rebuilt and there may be a new future which will come from the dust. I've been in touch with people in my University Medical school in Oxford to see whether we can do something about getting these young people's education continued.  

You can imagine there wasn’t a lot of laughter in the whole environment, but on the few occasions when I did gather together with my colleague’s small group of young students and volunteers, usually late into the night, we would eat whatever food goodies they had to hand, and their sense of fun would burst out. Together there was a very strong sense of community amongst them. 

How did your Christian faith inform the way you interacted with the situation? How did your Christian faith help you process what you were seeing and experiencing there? 

 I must say it was a deeply spiritual time for me. It was absolutely powerful to me to know that God cares and loves each and every one of these people. I longed to organise a football game with the kids. I was told that they had tried to do that, and it had become too dangerous. So there seemed to be no organisation around looking after the well-being of the children, their education, or the deeper impact on them of this war. People were jammed into the hospital, obviously because it was seen as a safe space, and it was humbling to think that us (as foreign workers) being there made them feel somewhat safer. It humbled me immensely.  

I felt nothing but a sense of privilege in being a witness to all this. I was reading the Psalms regularly in daily prayer. There's also something about that land being the place where God himself suffered in Christ and went through his own agony, and that the Holy Family escaped through Gaza to Egypt.  

I genuinely don't feel brave, I don't. I'm not the kind of person who sees lights in the sky, but I know it was God’s calling to go there. It was simply the right thing, a privilege and an honour to have such access which comes with having my particular background of skills and past history with Gaza. God is over all these matters, and we are compelled to respond. 

 

Tim Goodacre is a Reconstructive Plastic Surgeon based in Oxford, with extensive experience of working in diverse environments outside the UK. He is immediate past Vice President of the Royal College of Surgeons of England.