PTSD & Secondary Wounding

As important to the healing process as other people are, it's an unfortunate truth that often people do more harm than good. Strangers who don't understand your situation can be unintentionally cruel, but so can those who should know better: family, friends, and helping professionals. Instead of being supported, you have been made to feel ashamed of having been a part of the traumatic event in the first place, of your reactions to the event, or the symptoms you have developed as a result, or even for asking for help.

You may have heard, for example, "You weren't hurt enough to be entitled to benefits, " or "It happened years ago. You should be over it by now." Such attitudes exist even in the most obvious and horrendous cases of victimization.

Secondary wounding occurs when the people, the institutions, caregivers, and others to whom the survivor turns for emotional, legal, financial, medical, or other assistance respond in one of the following ways:

Disbelief:

Commonly, people will deny or disbelieve the trauma survivor's account of the trauma. Or they will minimize or discount the magnitude of the event(s), its meaning to the victim, its impact on the victim s life.

Blaming the Victim:

On some level, people may blame the victim for the traumatic event, thereby increasing the victim's sense of self-blame and low self-esteem.

Stigmatization:

Stigmatization occurs when others judge the victim negatively for normal reactions to the traumatic event or for any long-term symptoms he or she may suffer. These judgments can take the following forms:

• Ridicule of, or condescension toward, the survivor
• Misinterpretation of the survivor's psychological distress, as a sign of deep psychological problems or moral or mental deficiency or otherwise giving the survivor's PTSD symptoms negative labels.
• An implication or outright statement that the survivor's symptoms reflect his or her desire for financial gain, attention, or unwarranted sympathy.
• Punishment of the victim, rather than the offender, or in other ways depriving the victim of justice.

Denial of Assistance:

Trauma survivors are sometimes denied promised or unexpected services on the basis that they do not need or are not entitled to such services or compensation.

Causes of Secondary Wounding

In essence, secondary wounding occurs because people who have never been hurt or traumatized have difficulty understanding and being patient with people who have been hurt. Secondary wounding also occurs because people who have never been confronted human tragedy are sometimes unable to comprehend the lives of those in occupations that involve dealing with human suffering or mass casualties on a daily basis.

In addition, some people simply are not strong enough to accept the negatives in life. They prefer to ignore the fact that sadness, injustice and loss are just as much a part of life as joy and goodness. When such individuals confront a trauma survivor, they may reject, depreciate or ridicule the survivor because that individual represents the parts of life they have chosen to deny.

On the other hand, it also happens that trauma survivors are rejected or disparaged by other survivors those who have chosen to deny or repress their own trauma and have not yet dealt with their loses or anger. When trauma survivors who are not dealing with their traumatic pasts see someone who is obviously suffering emotionally or physically, they may need to block out that person in order to leave their own denial system intact.

The following sections give a brief run-down of some of the common causes of secondary wounding.

Ignorance:

Some secondary wounding stems from sheer ignorance. Especially in the past, there were few, if any, courses on PTSD available to medical, legal, and mental health professionals. Today such courses are available in many locations; however, they are not a required part of the training in any of those fields.

Burnout:

Another cause of secondary wounding is that many helping professionals are themselves suffering from some form of PTSD or burnout. As a result of having worked for years with survivors, they (like those survivors) are emotionally depleted. They may also, like many survivors, feel unappreciated and unrecognized by the general public and by those in their workplace.

"Just World" Philosophy:

Another hurdle victims face is the prevalence and persistence of the "just world" philosophy. According to this philosophy, people get what they deserve and deserve what they get. The basic assumption of the "just world" philosophy is that if you are sufficiently careful, intelligent, moral, or competent, you can avoid misfortune. Thus people who suffer trauma are somehow to blame for their misfortune. Even if the victims aren't directly blamed, they are seen as causing their own victimization by being inherently weak or ineffectual.

The Influence of Culture:

Our nation was founded by individuals who overcame massive obstacles by means of hard work, self-sacrifice, and physical and emotional endurance. As a nation today, as in the past, we pride ourselves on the can-do spirit and our American ingenuity we are certain we can overcome almost any hardship. The American dream tells us that our country is so bountiful and so full of opportunities that anyone who wants the good life can have it; all they have to do is pull themselves up by their own bootstraps.

Abraham Lincoln is quoted as saying, "People can be happy as they make up their minds to be," implying that in the personal realm, man can be master of his own fate. If only he were right.

Excerpts from I Can't Get Over It - A Handbook for Trauma Survivors
Author: Aphrodite Matsakis, Ph.D.

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