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Strong emotions normal after trauma, expert says

By Mary Carter
CNN

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ATLANTA, Georgia (CNN) -- Kacey Ruegsegger Johnson wants the Virginia Tech shooting survivors to know that their pain and anger and fear are normal. And she wants them to know it will get better.

She knows.

Eight years ago Friday, Kacey was in the library of Columbine High School in Littleton, Colorado, when her fellow students Eric Harris and Dylan Klebold walked in and opened fire. Twelve students and one teacher died in the boys' rampage, which ended when they took their own lives. At the time, it was the worst school violence in U.S. history.

"Things will get better," says Johnson, now 25 and living in suburban Denver, Colorado. "It's going to be really hard and you're going to have all these emotions, but what you do with those emotions determines what this experience does to your life."

"All these emotions" -- anxiety, fear, depression -- are a normal response to violence, says Dr. Sheila Jowsey, a practicing psychiatrist and assistant professor of psychiatry at the Mayo Clinic in Rochester, Minnesota.

"It's shocking and it's going to be very typical for people to be upset," she said. "This is the way we as human beings react, and we don't want to medicate or take any of that away.

"In the first few days, all of us -- anybody who's heard this -- feels upset, and the closer you are to the event, the more upsetting and disorganizing this will feel."

The American Psychiatric Association's Web site offers specific tips for dealing with a trauma or disaster, and helping a loved one through such an event, she said.

Those most closely touched by the violence are likely to seek the safe and the familiar, Jowsey said -- family, friends, clergy, perhaps a physician.

"These folks will be angry, depressed, anxious, upset for brief periods of times," she said. "In the initial few days, there'll be a lot of strong emotions. ... What we want is for people to know that the strong feelings are normal and to talk about them."

Why does talking about a trauma help? It has to do with regaining control over intense, primal feelings, Jowsey said.

"The part of our brain where speech is located is a sophisticated part of our brain," Jowsey said. "The emotional part of our brain is pretty unsophisticated. So if you don't talk about the feelings, you're left with this very strong sensation that feels very uncomfortable. But sometimes in the process of putting those feelings to words, you can kind of step back from the strong feelings and get a sense of mastery over the feelings, so that it doesn't feel like it's something churning within you."

Through talking, she said, the event becomes "something that you can visualize or put a timeline to, it becomes less chaotic and you get a sense of order or understanding and that seems to have a very beneficial effect."

Talking is important, she said, but forcing someone to talk is not the best option. She recommends gentle encouragement and reinforcement that recounting their experience to family and friends or perhaps fellow survivors, may help them feel more in control.

CNN Chief Medical Correspondent Dr. Sanjay Gupta echoed that sentiment. "Some of the most useful people in a situation like this are other people who have gone through this," he said. That common bond is part of what created the power of Tuesday night's candlelight vigil on the Virginia Tech campus, he said.

As those directly affected get back into a regular routine, most people's symptoms will start to improve, Jowsey said. But if that isn't happening, it could be that they are developing post-traumatic stress disorder.

PTSD is most commonly associated with war or battle experience; a July 2004 study in the New England Journal of Medicine concluded that at least 15 percent of four combat units surveyed met the criteria for a PTSD diagnosis.

But PTSD can touch anyone who has experienced or witnessed violence. The National Center for Posttraumatic Stress Disorder identifies three key symptoms: reliving the traumatic event; avoidance and numbing, which means trying to stay away from reminders of the event and feeling emotionally isolated or flat; and "hyperarousal," a heightened state of watchfulness or alert that can lead to disruptions in sleep and angry outbursts.

People who have these feelings a month or more after the traumatic event may want to seek counseling and have a mental health professional review their symptoms.

Clinical psychologist Dorinda Miller, who was on the Virginia Tech campus with the Red Cross this week, estimated that between 4 percent and 11 percent of trauma victims could be expected to have what she called "a pathological outcome from this," meaning a diagnosed mental condition.

Jowsey stressed that most people to do not develop PTSD.

"We have a tremendous capacity to get to a better place," Jowsey said. "Terrible things can affect us and make us feel very distressed, but help can make us feel better too. So the help that people are offering, reaching out trying to be supportive, caring expressions, offering assistance, all of this has a mitigating effect .... It's not that they won't hurt, they won't remember the event, but that they will have been able to manage their distress and move forward."

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