Published on September 26th, 2013 | by Dr. Philip Monroe

What A Bosnian Doctor Held In Six Concentration Camps Says About Trauma Recovery

Dr. Philip Monroe is a trauma recovery specialist. Here he shares three words and three goals to help with trauma recovery and offers insights from the experience of Esad Boskailo, a Bosnian doctor who survived six different concentration camps and is now a psychiatrist in the US working with trauma victims.

Three Words for Trauma Recovery

Healing? Recovery? Integration? These words contain information, movement, and emotion. What words do you like to use when describing the process of getting better after a traumatic experience?

How do you communicate that you are better but not so much better that you have no more bad memories; that you have no more nightmares; that you are not triggered into panic when you see someone who abused you?

What words do you shy away from?

Let’s consider three options.

Healing

Some hear healing language as a completed task. “I have been healed.” Past tense. If I was in a wheelchair but now I walk…would I say I have been healed if I walk with a limp or need a walker to get around?

Do you ever hear someone say, “I was healed, in part”? Would it be better to say “I am being healed” or “I am recovering”?

Compared to Greek verb tenses, our English language doesn’t communicate well the ongoing state of something. In Greek, we can communicate a present perfect tense such as, “I was and am currently being healed” all in one verb form. But in English, we cannot communicate such an ongoing process without more words. Thus, when we use the shortcut, “I am healed,” it sounds like a finished job.

Recovery

What about recovery? Restoration? Renewal? Recovery words are popular amongst former addicts. For them it connotes that they are no longer using but making the daily choice for sobriety. However, they recognize the danger exists of falling back into drunkenness and so they communicate that they are in a lifelong process. For some, however, recovery sounds like a failure—failure to find victory and failure to accept a new identity. The truth is, few people outside of AA use the word recovery in every day speech. The other “r” words are more likely used in Christian circles but not so much in discussion of life after trauma.

Integration

In Wounded I Am More Awake: Finding Meaning after Terror by Julia Lieblich and Esad Boskailo, Julia helps tell Esad’s experience of being a Bosnian doctor held in six different concentration camps. He is now a psychiatrist in the US and works with trauma victims. He faced much brutality in being treated worse than an animal and so was not in good physical or psychological shape when he came to the U.S. I commend the book to those who want a basic understanding of trauma and of this thing we are trying to call healing or recovery. Read these quotes from Esad the psychiatrist:

[said to another survivor] “I can’t take away what happened. But [I] can help [you] imagine a better future.”

 

“You are fifty, not twenty-five. You will never be the person you were twenty-five years ago. Even if you didn’t have trauma, you would not be the same.”

What Esad is arguing for is integrating trauma into one’s present life. One cannot go back and recover what was lost. A trauma survivor is never going to be free from losses suffered. To do so would be to deny truth.

Integration means allowing the reality of trauma and its losses while finding meaning and value to live in the present with hope and even joy. Integration requires acceptance and willingness to look for meaning and purpose.

I like the connotations of integration. But, I am not sure I like the word integration since it also doesn’t connote some level of arrival at a good enough place. What word would you use?

Three Goals for Trauma Recovery

While words are important and carry much meaning, it may be more helpful to consider what recovery goals are helpful for trauma victims. While we know the recovery road can be long and arduous, it helps to know when we make progress and have a general sense of the direction we are headed.

In the days before GPS, if you went on a long car trip, you probably consulted a map on several occasions in order to make sure you were headed in the right direction. So also, when you are working to get better after a traumatic experience, you want some sense you are still working on good goals. This need is especially great if the traumatic symptoms are complex and the treatment not brief (think war, genocide, child sexual abuse, etc.).

Esad works toward these three goals that in turn support the ultimate goal: thriving. (Notice that the goal is not being free of symptoms, free of triggers, or back to life as if the trauma did not happen.)

  1. Acknowledge losses
  2. Foster resiliency (i.e., build the capacity to use current coping resources)
  3. Find meaning in life again

I think these steps function well as helpful signposts or intermediate goals in the process of recovery from traumatic experiences.

Now, I don’t believe these goals are necessarily in sequence.

Some people stumble on something that gives new meaning to life and thus are better able to acknowledge losses. Others get to work on building better coping mechanisms (e.g., a veteran puts away items that cause him or her to dissociate, an adult victim of CSA stops cutting and develops acceptance strategies, etc.) and then can acknowledge losses.

So, in the murky water of therapy (and it surely is murky!), the trauma victim can find some comfort in activities pointing to these intermediate goals. Each day they reject self-condemnation for not being who they used to be before the trauma, they are moving toward thriving. Each day they embrace available coping resources (e.g., a friend who will call or pray), they are moving toward thriving. Each day they find one meaningful experience, they are moving toward thriving.

Photo from Mostar titled “War Was Here” by Enrica Bressan.

To comment on this article or for links to some of Dr. Monroe’s other writings on trauma and recovery, see the blog post Complex Trauma and Other Reading.



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