Post Traumatic Stress

The Trauma Narrative

Author: Dean Bonura, Author of "Beyond Trauma: Hope and Healing for Warriors"

Photo by Marines is licensed under CC BY 2.0

November 13, 2017

But when I thought how to understand this, it seemed to me a wearisome task, until I went into the sanctuary of God; then I discerned their end. —Asaph

The experience of trauma is an irreversible event. We cannot change what happened to someone who was traumatized. But we can help that person change the way she or he views the event. Life is like a script, composed of events and choices—some good, some bad—enacted by a cast of characters. The story line is supposed to make sense. But trauma dramatically affects the script. It totally disrupts the story line.

Sufferers struggle to make sense of their traumatic experience. How do we make sense of death and violence, the loss of comrades, or the loss of innocent civilians? How do we comprehend the suffering of the innocent and the magnitude of war? How do we fit the experience of trauma into the script?

So far we’ve examined the spiritual effects of trauma, particularly the many forms of loss associated with trauma, reasons for suffering, the seemingly inexplicable nature of evil, and concepts of confession and forgiveness associated with guilt and shame. In this chapter and in the remaining chapters, I explain the concepts of narrative reconstruction and narrative reframing. The use of narration when addressing traumatic experiences is an effective technique for correcting cognitive distortions associated with trauma.

I’ll apply these concepts as we consider in more detail the suffering of Christ and other biblical models for healing, which teach new ways of viewing trauma and aid in healing. We’ll learn through the passion of Christ (building on what we discovered in chapter 7) and through the experiences of Job, David, and Paul how trauma has an “upper side” unseen by us. While we may understand more as we acquire new information and insight, we also recognize that sometimes we understand less. However, the example of Christ and the experiences of Job, David, and Paul all illustrate how trauma may be reframed to provide new meaning and enable healing for the traumatized who come into your care.

The Trauma Narrative

Learning to reconstruct the trauma narrative and reframe trauma in religious terms leads to healing, post-traumatic growth, and greater satisfaction for many victims. These two aspects of narration are extremely useful in learning to reappraise events using biblical stories.[1]

Generally, the use of stories helps by enabling soldiers to connect emotions with facts and events.  Stories clarify perceptions. When stories are used in the company of others, confidence is built in the sufferer and the expression of support is enabled. We learn from one another’s stories and experiences.  Talking eases the pain associated with trauma.

Narration may be verbalized or written. Both are useful techniques. When conducted in the context of a supportive, caring group, such as a church group or a group of fellow veterans, the interaction is therapeutic. Also, retelling the story tends to normalize the trauma and reduce the stress associated with it.

Narrative Reconstruction

Narrative reconstruction is an essential element of debriefing. When used effectively, it addresses not only the facts associated with the traumatic event but also the victim’s thoughts, emotions, and actions. Its use normalizes the traumatic experience. Employed early on, reconstruction mitigates negative stress reactions that typically occur later, such as PTSD.

In narrative reconstruction, the warrior is encouraged to relate the traumatic event in orderly detail, to address misconceptions and distortions.  Since the experience of trauma is so emotionally laden, memories may be distorted. The retelling of the event serves to clarify perceptions, with the goal of normalizing the traumatic event for the sufferer.

Since the experience of trauma is so emotionally laden, memories may be distorted

According to some research, the retelling of the traumatic story reduces its power over the sufferer, which serves to normalize the effects of the traumatic event. (While the event itself is extraordinary, the reactions are normal.) Emphasizing the normalcy of PTSD reactions counters the negative perception of some that leads them to say, “I have a mental disorder.” Though this assessment may be clinically accurate, I don’t think it contributes to positive outcomes. I would rather emphasize that the sufferer, diagnosed with PTSD, is just reacting normally to an extraordinary or abnormal event(s).

Writing about the event is another way of using narrative reconstruction. Writing can help people share more easily their most painful thoughts. Writing identifies the sources of pain and addresses those sources in ways that can lower stress.[2]  One variation of “traumatic writing” is artistic expression through drawings or paintings. I’ve observed its use and believe it is also therapeutic.

Narrative Reframing

Narrative reframing incorporates new information into the narrative so that the sufferer may be able to separate the memory of the traumatic event from the painful emotions associated with the event. Narrative reframing is often used with narrative reconstruction, and their goals are the same—to correct distortions and perceptions. In narrative reframing, however, the idea is to incorporate new information so that perspectives are adjusted. The new information changes the script, and the result is the acquisition of a different perspective on the traumatic event.

Reframing trauma, sometimes referred to as cognitive restructuring, not only requires the introduction of new information but the willingness of the sufferer to explore new possibilities. The introduction of new information dramatically affects the emotional link to the trauma by reducing the power of the emotions associated with the memory of the event.

Another way of understanding how reframing works is to imagine a box. Let’s suppose that within the box, ordinary life experiences occur. Life is lived inside this box. Everything has its place; life is predictable. Things operate according to accepted standards and expectations. But suddenly and unexpectedly, trauma strikes. It takes the victim outside of the box, outside the range of ordinary human experience, creating dissonance, disruption, and dysfunction.

Reframing is enlarging the boundaries of the box in order to contain or accommodate the new experience. Or to use another analogy, it is enlarging one’s circle of assumptions.[3]

Narrative reframing works well with cognitive behavioral therapy. It is effective when used with narrative reconstruction and when religious themes are included. Both are evidenced-based treatments that show great promise and are easily adaptable when making spiritual interventions.[4]

Reframing Changes the Perspective

You can also think of reframing like opening the lens aperture of a camera. Trauma causes a person to “zoom in” on what has happened to them. Victims tend to focus on themselves; they become introspective. In a sense, they experience tunnel vision and lose all of their peripheral vision. They are so close to this experience they cannot see the forest for the trees. Reframing forces the victim to “zoom out” and adjust the picture. It changes the perspective. Undetected images emerge. More is revealed. A new appraisal constrains the sufferer to adjust preconceived notions, biases, or misconceptions. When we introduce new information, we enlarge the picture, and it requires a bigger frame.

Reframing Delinks the Painful Memory

Reframing the narrative provides a new perspective that helps sufferers discover meaning in their trauma by connecting their present experience to past experience in a way that delinks the painful memory of their trauma from their present experience. If sufferers can account for their traumatic episodes by the introduction of new information, then they are able to assign meaning and find a place for it in their stories. The assignment of meaning to the event moderates emotions. The activity helps the victim place the event back in the past where it belongs, lessening the emotional connections that the victim is making in the present. The original event has less power over the victim in the present, which is the goal of treatment—to lessen the intrusion and regain functionality.

The original event has less power over the victim in the present, which is the goal of treatment

Reframing, then, is successful when the constant reliving of the trauma is transformed into simple remembering of the trauma. This process gives the wounded warrior perspective on the enduring present, providing the ability to place the trauma in the past. By doing so, the veteran is relieved of enduring the past in the present, and gains an appreciation for the future.[5]  This is making peace with memory; it is putting the past where it belongs.[6]

Biblical Models for Healing

Theologically and spiritually speaking, these narrative themes resonate and should enable healing in veterans, who learn again to remember. Biblical models for healing—exemplified in the stories of Job, David, and Paul, along with the paradigm of the cross of Christ—all point to the efficacy of reframing the trauma narrative in ways that lead to healing. I am persuaded that these stories and similar stories, if they strike an emotional chord with the sufferer, can facilitate an emotional disconnect from the traumatic past.

The Benefits of Reframing the Narrative in Religious Terms

Others have successfully accommodated the use of narration and cognitive reframing to religious themes.[7]  They have concluded that religious reframing of traumatic events is beneficial for those suffering from PTSD. In an article on religious reframing in The International Journal for the Psychology of Religion, the authors predicted that the use of religious themes in writing about emotionally laden events would moderate participants’ mood states. Fifteen participants with PTSD wrote about their PTSD-triggering events in three sessions. Eighty percent of the participants included religious themes in their narratives. In those cases where religious themes were evident, a positive mood change was noted by the time of the third writing session, whereas those who did not use religious themes continued to indicate negative moods.[8]

In sessions I conducted, I encouraged journaling so participants could record their reactions and insights from group appraisal activities. Participants shared with the group anything they wanted to from their journals. I found that participants who shared their reactions and insights experienced an improvement in their perception of wellness. Like debriefing activities, journaling provided a way for soldiers to check their feelings, thoughts, and actions.

Reframing goes hand in hand with narrative reconstruction. Normalization is evident when the sufferer is able to relate his or her experience without severe emotional reactions. It is not unusual for a person to react to distorted perceptions of trauma. Through narrative reconstruction, the sufferer is able to clarify what occurred. With the aid of a facilitator and in the company of fellow sufferers, the activity is effective.

In a feasibility study I conducted during my research, I used several reframing activities. In one case, I explored the use of a psalm as a tool for assisting soldiers in reframing their trauma in positive and healing ways. Each participant was encouraged to identify the particular trauma or event mentioned in the psalm, identify the symptoms expressed by the psalmist about the event, and then discover how the psalmist was able to reframe his experience, given new information revealed in the text. Participants found this exercise profitable. Many psalms may be used in this way. In other exercises, the group considered various passages that were connected with the death of Christ and explored how witnesses to the death responded to new information about the trauma of Christ.

With this information, participants were challenged to make connections to their own trauma and draw lessons from the experiences of the early disciples.[9]  In the next chapter, we’ll consider an example of narrative reframing that pertains to the crucifixion.

Recasting Assumptions

When we learn to reframe the trauma narrative, we are recasting assumptions about our experience. All of us have assumptions about how the world operates, such as “The good are rewarded and evil people are judged” or “God always keeps us safe.” But we also know that things do not always operate according to our assumptions.

we also know that things do not always operate according to our assumptions

The story of Job is one example. When things occur outside of the sphere of our assumptions, they challenge our worldview and create dissonance. This is often how trauma works. It disrupts. It challenges our assumptions and our beliefs. When a trauma victim learns to incorporate biblical information into the equation of suffering, she or he discovers new insights.

Recasting the Narrative: Psalm 73

Psalm 73 offers a classic illustration. In the psalm, Asaph, while acknowledging the goodness of God to those who are good, readily admits his inability to comprehend the prosperity of the arrogant and the wicked. “But as for me, my feet had almost stumbled, my steps had nearly slipped. For I was envious of the arrogant when I saw the prosperity of the wicked.” He assumed that while God blesses the good, he also curses the bad. But this was apparently not the case. The wicked people he observed flourished. “For they have no pangs until death; their bodies are fat and sleek.” Indeed, they are full of pride and readily defy God himself. How can this be? It doesn’t make any sense. In the chart below (fig. 8.1), I apply the reframing concept to the situation of Asaph from Psalm 73.

Figure 8.1. The Reframing Concept

 

We’ve learned that trauma often interferes with our concepts of what is right, true, and good. Typically, a soldier who is suffering from the effects of a traumatic episode—let’s say the unexpected loss of a comrade—has many questions or concerns. She may ask, “Why did this happen?” Or she may comment, “This doesn’t seem fair!” He may question, “How did this happen?” Or he may exclaim, “This doesn’t make any sense!” These reactions are all valid. They represent the varied and most certainly accurate responses of soldiers who struggle with a traumatic episode. Let’s look at these responses more closely.

Responses to Trauma

  • Why did this happen?

This question explores the problem of meaning and the sense of invulnerability that many soldiers experience. Typically, a younger, less experienced soldier cannot imagine his or her own demise. “It can’t happen to me!” They find it difficult to accept their vulnerable position. But the reality is quite different. We are all vulnerable to trauma, regardless of whether we are in combat or not. We live in a world in which bad things happen. Good people die early deaths. Children die. People suffer. War devastates millions. Sometimes it seems the ungodly get all the breaks. This was the observation of Asaph. He struggled with this observation. It nearly toppled him. It nearly ruined him.

The other part to this issue is the question of meaning. As we have observed in other places, warriors wonder why. It is our job as pastors and caregivers to assist warriors in discovering the meaning of their experiences. Sometimes, as in Asaph’s case, meaning becomes clear and assumptions are clarified. But in other cases, we may never know the precise meaning of a trauma. Job never received a clear and precise answer for his trauma, but he understood enough, later on. He was able to go on with his life, albeit a radically different life.

 

  • This isn’t fair!

This is another response often expressed by warriors who have been through a terrible situation. It is a reaction to apparent injustice. This was also the reaction of Asaph. He found it difficult to reconcile his concept of justice with what he observed among those who disregarded God. He played by the rules. He kept himself pure. But being good did not result in the outcome he expected. “All in vain have I kept my heart clean and washed my hands in innocence,” he exclaimed. He didn’t get any breaks. “For all the day long I have been stricken and rebuked every morning,” he moaned.

The problem of fairness resides in one’s perception. No one knows everything. We are limited, finite, and frail human beings. But many soldiers continue to suffer from their inability to reconcile what they observe with their concept of justice. Such perceptions lead to other problems like guilt and enduring grief.

 

  • How did this happen?

This question implies a frequent assumption: “This is not supposed to happen.” It reflects a limited perception, a tunneled view of the situation. The answer is simple: “It did happen.” Reframing or enlarging one’s “box” will accommodate the occurrence. The question gets at the problem of making meaning of the event. It goes with “Why did this happen?” As rational creatures, all people desire to make sense of things. This was the case with Job and his friends. They all wanted to make sense of his situation. They needed to.

This question may be easier to answer than the why question we examined above. When one asks how, the process that led to the outcome is explored. The harder assumption, “This is not supposed to happen,” gets at one’s worldview. If one accepts a world that is unfair, violent, and seemingly arbitrary, one is actually more prepared to deal with the question of how. Accepting a sovereign God, who allows evil for his purposes but never accepts responsibility for evil, can accommodate the seeming incongruity.

 

  • It doesn’t make any sense!

This observation is a variation of the search for meaning, which is so critical for healing. Through the expansion of perception and the acquisition of new information, a soldier may discover a pattern to what seemingly doesn’t make sense. This was the situation with Asaph. He found sufficient insight in the presence of God to accommodate his observations about the wicked. This is how life works for many of us. If only we can get a glimpse of God and a little peek at his plan, then we may realize God knows it all and will not abandon his people in the end.

Indeed, Asaph discovered much about himself, about God, and about his relationship to him. This leads to another observation about trauma: the problem of identity loss. Trauma often brings into question one’s view of self. Asaph was not only able to learn how to accommodate his observation of the wicked, he also learned how special he was in the sight of God. Having once thought he was “brutish and ignorant” about the matter, he realized God was there for him, holding him, and guiding him. He concluded, “My flesh and my heart may fail, but God is the strength of my heart and my portion forever.” God remained his dwelling place. God gave him a new identity. Asaph successfully reframed the narrative of his experience to accommodate his trauma, which resulted in new realization, new insights, and personal healing.

Trauma often brings into question one’s view of self

Pastoral caregivers should work toward a similar epiphany when assisting soldiers in reframing their trauma narratives. At the moment when a soldier realizes the meaning God has for him or her, the soldier is able to fit the event into his life script. I am convinced that if a person can work through this process, she or he will gain understanding and find healing.

Narrative Reconstruction and Scripture

Narrative reframing is critical to the healing process. Narrative reconstruction is also very important. I believe the reconstruction of the trauma narrative is the first step to be taken by the warrior who is struggling with the effects of combat-related trauma. Again, narrative reconstruction is the retelling of the traumatic event to clarify what actually occurred and the role an individual played in the event. It is ideally suited to critical incident stress debriefing, and it is an effective tool if used soon after the event. But it is also useful later, when a soldier may be suffering from post-trauma stress. It is a tool used with various treatments, such as trauma incident reduction or exposure therapy. The idea, similar to reframing, is that with the retelling of the event, the emotional memory associated with the event is normalized or “delinked,” and the power of the event over the individual (its intrusiveness) is lessened.

The Exodus story is an example of narrative reconstruction in Scripture. The Israelites endured four hundred years of slavery in Egypt, and their collective experience was traumatic. Their dramatic rescue from Egypt under the leadership of Moses, and the subsequent failure of Israel to enter into the Promised Land immediately, resulting in forty years of wandering in the wilderness, was also traumatic. As we consider this story in the Bible, we note it is often restated in part, to remind the people what happened to them and how God had rescued them (e.g., Deut.; Acts 7, 13). I believe the historical reconstruction of this trauma narrative served to normalize their national experience and contribute to their national identity. The retelling of the story not only reminded the people of their failures but also of God’s care and his promises to his people.

Another example of narrative reconstruction is the periodic restatement of God’s covenantal promises. A cursory survey of the Old Testament reveals that God often reiterates his promises to Israel and particularly to those whom he anoints to lead his people. Interestingly, the occasions of these restatements are commemorated in some fashion, usually by the construction of altars and the offering of sacrifices, and occasionally by congregational assemblies.

Consider the covenants. The Abrahamic covenant is amplified in the Davidic covenant; the Mosaic covenant is reframed in the new covenant (Gen. 12; 2 Sam. 7; Exod. 19–20; Jer. 31). These reconstructions serve as reality markers for the people; they are reminders of God’s promises. They clarify God’s purposes for his people. They guide the people toward their national destiny.

Memorials and Commemorations

Similar conclusions may be drawn from the use of memorials or memorial statements in Scripture. Whether it is the retrieval of twelve stones from the Jordan River for the construction of a memorial or the assembly of the nation to recite the “blessings and the curses,” these acts of memorialization commemorate events and contribute to the national memory. Their use secures tragic or triumphant events to the past.

We do the same in modern times. The Alamo Shrine, the USS Arizona Memorial at Pearl Harbor, and the 9/11 memorials all serve to solidify our national narrative. They say, in effect, “This is what happened here.” They serve as reminders of the sacrifices that were made and the significance of those sacrifices to the nation. Memorialization enables healing because it assigns meaning to the event. It honors those who made the sacrifice and places emotional distance between the event and those who survived, facilitating the delinking of the memory from the emotions, putting the past where it belongs.

Individually and collectively, we look to these memorials as markers of the past that remind us of actual events. But they are past events, less burdened by the emotions that once accompanied them. That’s another goal of story reconstruction—putting the past in the past and moving on with the present where the events of the past no longer crowd memories in the present.

The Circle of Assumptions

In the figure below of Robert Hicks’ “Circle of Assumptions,” the victim is trauma-focused.[10]  The circle of assumptions is narrowly focused and does not accommodate the traumatic event(s) represented by the Xs. (The Xs are outside the circle.) The circle is divided into quadrants, each reflecting a primary concern of the victim. In the upper left quadrant, the concern is invulnerability, the assumption is “the traumatic event can’t happen to me,” and the effect is fear and confusion. This effect is commonly experienced by victims of trauma.

 

Figure 8.2.  The Circle of Assumptions

 

In the upper right quadrant, the concern is rationality, the assumption is “the world makes sense,” and the effect is loss of meaning. In the lower left quadrant, the concern is morality, the assumption is “the universe is just,” and the effect is a sense of injustice. In the lower right quadrant, the concern is identity, the assumption is “I know who I am,” and the effect is loss of identity.

Victims may experience stress in all quadrants, depending upon the trauma and how it is appraised. Regardless, the victim must learn to enlarge his or her circle of assumptions to accommodate the trauma. Reframing opens the circle to make room for the trauma.

What happens when victims expand their circles of assumptions? They are forced to revise their assumptions to accommodate their experiences. They move from being trauma-focused to being reality-focused. They come to recognize that you can do everything right and still experience tragedy. They learn to accept the things they cannot change. They look for meaning in their pain and hopefully find it. They come to understand that the world is a mean place and many things are not fair. But more may be realized.

This is what it means to reframe trauma. It is what Hicks calls “enlarging your circle of assumptions.” With new information, there is a new realization. The victim comes to understand that God will deal with the inequities of life. God will judge evil men (as in Asaph’s situation). God will honor those who are faithful to him despite their suffering. This life is not everything. There is a future and hope. The story of Joseph is an excellent illustration of how God uses evil and suffering to accomplish his purposes—purposes not immediately apparent to the victim but eventually clarified.

With new information, there is a new realization

While this does not explain everything, it gives us assurance that God is engaged, aware, and in control, though it may not seem so at the time. In the next chapter, we will observe how the cross of Christ teaches that there can be great meaning in suffering that may also lead to profound healing. It explains how God uses evil to accomplish good.

 

You do not need to face this challenge alone. Jesus has conquered this challenge so that you can move from your present situation to a life of overcoming. Invite him to lead you in your journey. He will forgive, comfort, and heal you.

There are warriors who know what you are going through and can give you guidance. Please click one of the buttons below and allow one of them to help you.

[1] For example, Shay, Achilles in Vietnam; Tick, War and the Soul; Matsakis, Post-traumatic; Herman, Trauma and Recovery.
[2] Julie J. Exline, Joshua M. Smyth, Jeffrey Gregory, Jill Hockemeyer, and Heather Tulloch, “Religious Reframing by Individuals with PTSD When Writing About Traumatic Experiences,” The International Journal for the Psychology of Religion 15 (2005): 17–33.
[3] Hicks, Returning Home; Exline et al., “Religious Reframing.”
[4] Exline et al., “Religious Reframing.”
[5] Ibid.; Hicks, Returning Home.
[6] Grossman, On Combat.
[7] Exline et al., “Religious Reframing.”
[8] Ibid.
[9] McGrath, “Post-traumatic Growth.”
[10] Hicks, Returning Home, 150.