Case Analysis and Strategies of Intervention Plan
Part 1: Case Analysis
Trauma is a psychological response to disturbing and distressing events that stress and overwhelm the human ability to cope with different emotions and situations. Trauma causes damage to the normal operation of the human mind as it reduces the consciousness and sensitivity of the brain. There are numerous forms and causes of trauma, such as assault, domestic violence, sexual abuse, torture, and even exposure to war. These divergent forms of trauma have different symptoms and causes, but all cause significant damage to the psychological functions of the human brain. Trauma caused by exposure to war, also known as war trauma, is a psychological response to the stressful experiences and events that are associated with any armed conflict. War trauma is a ubiquitous condition that affects all people who have lived through the terrible experiences of war, whether soldiers or civilians caught up in the area of combat.
War trauma affects all parties involved in armed conflict from the professionally trained soldiers who get involved in the actual war to the civilians who witness and live in areas near the battlefields. War trauma also affects retired military personnel or veterans as a large number of war veterans suffer from post-traumatic stress disorder (PTSD). War trauma has been experienced since time immemorial and affects all people, irrespective of cultural background, age, or gender. During the American Civil War, war trauma was termed as “soldier’s heart”, as “shell shock” in the First World War, and “war neurosis” in the Second World War (Valkeakari, 2017). Among the American soldiers who fought in the Vietnam War, trauma was known as “combat stress reaction”. In the contemporary medical and military fields, war trauma is largely referred to as post-traumatic stress disorder (PTSD). PTSD is a stress response that is largely experienced by those people who have been subjected to life-threatening conditions such as war, where the raw emotions of fear, bravery, and anxiety are fully on display. According to Valkeakari (2017), though the number of veterans who suffer from PTSD varies depending on which conflict a veteran was involved with, more than 10 percent of all war veterans in the United States of America suffer from PTSD. Another 5 percent of soldiers in active service in the United States suffer from the effects of war trauma (Keynan, 2018). The number of civilians and more so children who suffer from war trauma due to experiencing the hellish events of war are significantly higher compared to those of soldiers and war veterans. According to Keynan (2018), more than 33 percent of civilians exposed to the events of armed combat suffer from war trauma. The uncertainty of war makes both soldiers and civilians live in constant anxiety, fear, and anticipation of the worst, therefore, exposing them to war trauma.
War trauma and PTSD are forms of complex trauma as they involve the exposure of military personnel and civilians to multiple traumas. War is hell as it exposes the average soldier and civilian to numerous real-life threatening scenarios and the deaths of their loved ones, friends, and comrades (Keynan, 2018). War trauma is a form of complex trauma as it is a result of planned, extreme, and repeated exposure of individuals to life-threatening situations. War takes place in numerous days and even years and is highly planned, therefore, exposing individuals involved in the war in planned and continuous stressful experiences. Sommerville (2018) argues that complex trauma mostly occurs between people as it takes an interpersonal form. War trauma is, therefore, complex trauma as war involves numerous antagonistic parties who engage in armed conflict. Moreover, complex trauma involves challenges with regulating one’s emotions, self-esteem, identity, and anxiety. Low self-esteem and anxiety are some of the symptoms experienced by those suffering from the effects of war trauma.
War normally involves soldiers who are engaged in the actual armed conflict and the civilian populations who are caught in between the battle zones. According to Sommerville (2018), the effects of war trauma are more severe among the civilian population compared to soldiers as civilians lack the minimum of training regarding life-threatening conditions. According to a study done by UNICEF, the most affected population demographics when it comes to war trauma are children who live near the battlefields (Sommerville, 2018). Children are the least equipped to deal with any life-threatening risk, as they cannot defend themselves or flee from the conflict zones without aid from adults. Children, therefore, end up witnessing people getting killed, experience shelling, some are sexually assaulted, and others being tortured or recruited as child soldiers (Manzanero et al., 2017). Over 45 percent of children exposed to war suffer from the effects of war trauma. This is much higher compared to the 33 percent of adults exposed to war who suffer from war trauma (Manzanero et al., 2017). Therefore, children need to be protected from experiencing war conflicts as they experience stressful events that forever change their psychological being and wholeness.
War trauma has numerous symptoms; however, some are more severe compared to others. The general symptoms of war trauma include nightmares of the experienced events, grotesque and frightening memories of the experienced events, flashbacks, anxiety, memory gaps, lack of interest in normal activities, paranoia, withdrawal, and depression. The most severe of the above symptoms are depression, withdrawal, and anxiety. According to Sommerville (2018), depression is normally associated with and caused by guilt, shame, and remorse. This normally affects soldiers and civilians who survive the aftermath of the war and feel massive guilt that they survived while their loved ones and comrades perished. Scull (2019) defines anxiety as a state of constant worry and apprehension about the future. Most war trauma victims live in a state of constant fear of death informed by the horrific events they experienced in the war. Lastly, withdrawal is characterized by the complete social detachment of a person. Withdrawal is mostly caused by both anxiety and depression, which makes war trauma victims seek solace in their thoughts, therefore, cutting out other people from their lives.
People react differently to trauma, depending on the form of trauma they are experiencing. People suffering from war trauma experience a heightened range of reactions characterized by high anxiety, fear levels, and emotional numbness or immobilization. According to Munjiza et al. (2017), the reactions exhibited by individuals suffering from war trauma may be classified into emotional, cognitive, physical, and interpersonal reactions. Emotional reactions concerning war trauma may include excessive paranoia, anger, grief, anxiety, and shame. Cognitive reactions may take the form of indecisiveness and poor concentration. The physical reactions may include tension, fatigue, and a change in sex drive. Lastly, interpersonal reactions may include truancy and withdrawal. Due to the complex nature of war trauma, most people suffering from war trauma are highly anxious about the future, restless, and quite unsettled (Munjiza et al., 2017). This is largely due to the fear they experience as they relive the events they went through during the war. War trauma affects numerous communities beginning with the civil community and transcends to the military community. The effects of war trauma are felt most by the civil community that is thrust headfirst into the experience of war (Scull, 2019). The military community is also affected by the effects of war trauma as they are the ones who participate in the nitty-gritty of wars. The health community is also affected by the effects of war trauma as they are charged with rehabilitating the mental health of individuals suffering from the effects of war trauma.
Keynan, I. (2018). The Memory of the Holocaust and Israel’s Attitude toward War Trauma, 1948–1973: The Collective vs. the Individual. Israel Studies, 23(2), 95-117. Retrieved from www.jstor.org/stable/10.2979/israelstudies.23.2.05
Manzanero, A. L., Crespo, M., Barón, S., Scott, T., El-Astal, S., & Hemaid, F. (2017). Traumatic Events Exposure and Psychological Trauma in Children Victims of War in the Gaza Strip. Journal of Interpersonal Violence, 088626051774291. DOI: 10.1177/0886260517742911
Munjiza, J., Britvic, D., Radman, M., & Crawford, M. J. (2017). Severe war-related trauma and personality pathology: A case-control study. BMC Psychiatry, 17(1). DOI: 10.1186/s12888-017-1269-3
Scull, A. (2019). Trauma. In Psychiatry and Its Discontents (pp. 217-229). Oakland, California: University of California Press. Retrieved from www.jstor.org/stable/j.ctvh1dj1d.17
Sommerville, D. (2018). A Burden Too Heavy to Bear: War Trauma, Suicide, and Confederate Soldiers. In Aberration of Mind: Suicide and Suffering in the Civil War–Era South (pp. 23-48). Chapel Hill: University of North Carolina Press. Retrieved from www.jstor.org/stable/10.5149/9781469643588_sommerville.5
Valkeakari, T. (2017). War, Trauma, Displacement, Diaspora: Toni Morrison’s and Caryl Phillips’s African American Soldiers. In Precarious Passages: The Diasporic Imagination in Contemporary Black Anglophone Fiction (pp. 99-130). Gainesville; Tallahassee; Tampa; Boca Raton; Pensacola; Orlando; Miami; Jacksonville; Ft. Myers; Sarasota: University Press of Florida. DOI:10.2307/j.ctvx071tg.8
Part 2: Strategies of Intervention Plan
Numerous strategies and medical interventions are employed in the treatment of the effects of war trauma. According to Troxel et al. (2015), the strategies and interventions for treating war trauma include anxiety and depression management, medication, exposure therapy, psychodynamic psychotherapy, and cognitive restructuring. However, the two most effective evidence-based practice treatment models for war trauma are exposure therapy and cognitive restructuring. These are evidence-based practice intervention models that incorporate psychology in the management and treatment of war trauma. Exposure therapy involves the patient suffering from war trauma being made to confront his or her feared situations to combat both paranoia and anxiety. Exposure therapy is based on the fact that the major impediment to recovery concerning trauma is the general inclination of the human mind to avoid situations, emotions, and memories that are painful, disgusting, and stressful (Patel & Stein, 2015). Since avoidance only provides temporary relief, exposure therapy exposes the patient to those distressing emotions and thoughts to guarantee long-term relief. Therefore, exposure therapy is way more effective as it provides long-term relief to the effects of war trauma compared to other interventions focused on short-term relief. Cognitive restructuring focuses on identifying the maladaptive and negative thoughts that cloud the mind of a patient suffering from war trauma, dispute and challenge those thoughts, and replace them with a positive and realistic thought perspective (Oatley, 2018). Cognitive restructuring is also an effective method of treating war trauma as it focuses on rationalizing, replacing, and changing the negative experiences that instigated the trauma in the first place.
Both cognitive restructuring and exposure-therapy medical interventions incorporate psychology in the treatment of war trauma. Cognitive restructuring involves the analysis of an individual’s thought patterns, belief systems, and interpretation of past events and uses that information to reform and restructure the individual’s thoughts into positive vibes (Lancaster et al., 2016). Cognitive restructuring is important in dealing with the emotional and cognitive reactions of those suffering from war trauma as it targets the emotional brain that is charged with the cognitive duties of processing emotional stimuli. Exposure therapy involves working through the trauma by making the individual suffering from war trauma come to terms with the past distressing experiences. According to Watkins et al. (2018), exposure therapy can be very difficult and demanding at first as the patient is forced to relive the horrendous events of the past that trouble his or her conscious. With subsequent exposures, though, the patient becomes accustomed to and acknowledges his/her past, however dark it is.
The medical interventions of cognitive restructuring and exposure therapy have a three-step recovery phase for individuals suffering from war trauma. The first step of recovery is the safety and stabilization step that focuses on the stabilization of a war trauma patient. Most war trauma patients feel unsafe in their bodies as they constantly relive the distressful events of their past. The safety and stabilization step ensures that the patient is comfortable with him/herself (Boehnlein, 2016). Stabilization can be best achieved through meditation and yoga exercises aimed at increasing one’s self-consciousness. Boehnlein (2016), argues that only a self-conscious patient who understands the operations of his mind can be successfully subjected to both cognitive restructuring and exposure therapy as medical interventions for complex trauma. The next step is remembrance and mourning, and it involves the patient processing the trauma, putting it down in writing, and attaching emotions to it. This step is crucial in the exposure-therapy medical intervention as it is where the patient confronts his or her dark past and inner demons in a bid to placate and silence them (Green, 2018). The remembrance and mourning step is important as it enables the patient to accept, mourn, and embrace the past, and therefore, release any emotional and cognitive baggage in preparation for self-acceptance. The last phase is the reconnection and integration phase that involves the patient coming to terms with reality and setting a new purpose in life. The reconnection and integration phase involves the war trauma patient reconnecting with the real world, and therefore, making new and meaningful relationships (Kessels et al., 2017). Individuals take varying amounts of time in the reconnection and integration step, as it largely depends on how many stressful events each individual was exposed to in the past.
Most of the people who suffer from war trauma face various challenges in their bid to seek medical intervention. The medical interventions needed in the treatment of war trauma, such as cognitive restructuring, which requires the input of psychologists, are quite expensive; therefore, the majority of individuals suffering from war trauma are left unattended. Moreover, there is a limited number of trauma psychologists and professionals, more so those experienced in dealing with war trauma is also a big barrier to accessing treatment to war trauma. Lastly, most governments and non-governmental organizations only focus their attention on helping soldiers who suffer from the effects of war trauma to the total exclusion of the civilians who are caught up in the crossfires of war. The alienation of civilians suffering from war trauma from government-funded complex trauma intervention programs needs to be stopped as evidence shows that the civilians are the worst affected during wars.
Boehnlein, J. (2016). From Shell Shock to PTSD and Traumatic Brain Injury: A Historical Perspective on Responses to Combat Trauma. In Hinton D. & Good B. (Eds.), Culture and PTSD: Trauma in Global and Historical Perspective (pp. 155-176). University of Pennsylvania Press. Retrieved from www.jstor.org/stable/j.ctt18s318s.7
Green, B. (2018). Post-traumatic stress disorder. Problem-Based Psychiatry, 121–128. DOI: 10.4324/9781315379883-8
Kessels, E., Nozawa, J., Veldhuis, T., Entenmann, E., & Van der Heide, L. (2017). Correcting the Course: Advancing Juvenile Justice Principles for Children Convicted of Violent Extremism Offenses (pp. 23-30, Rep.) (Lefas M., Ed.). Global Center on Cooperative Security. DOI:10.2307/resrep20261.8
Lancaster, C., Teeters, J., Gros, D., & Back, S. (2016). Post-traumatic Stress Disorder: Overview of Evidence-Based Assessment and Treatment. Journal of Clinical Medicine, 5(11), 105. DOI: 10.3390/jcm5110105
Oatley, K. (2018). Mental Illness, Psychosomatic Illness. In Our Minds, Our Selves: A Brief History of Psychology (pp. 137-152). Princeton; Oxford: Princeton University Press. DOI:10.2307/j.ctvc778rs.14
Patel, V., & Stein, D. (2015). Common Mental Disorders in Sub-Saharan Africa: The Triad of Depression, Anxiety, and Somatization. In Akyeampong E., Hill A., & Kleinman A. (Eds.), The Culture of Mental Illness and Psychiatric Practice in Africa (pp. 50-72). Indiana University Press. Retrieved from www.jstor.org/stable/j.ctt16gz69f.6
Troxel, W., Shih, R., Pedersen, E., Geyer, L., Fisher, M., Griffin, B., & Steinberg, P. (2015). Evidence-Based Interventions to Treat Sleep Disturbances Among Servicemembers. In Sleep in the Military: Promoting Healthy Sleep Among U.S. Servicemembers (pp. 85-100). Santa Monica, Calif.: RAND Corporation. Retrieved from www.jstor.org/stable/10.7249/j.ctt15zc8f8.13
Watkins, L. E., Sprang, K. R., & Rothbaum, B. O. (2018). Treating PTSD: A Review of Evidence-Based Psychotherapy Interventions. Frontiers in Behavioral Neuroscience, 12. doi: 10.3389/fnbeh.2018.0025