Invisible Scars: How Highly Resilient People React to Trauma

Boston04/21/14- At the Boston Marathon at the finish line ground level on Boylston Street. S. Spectators stand at the site of the first bomb as a small memorial cross sign for the victims of the 2013 Boston Marathon is tucked away next to the sidewalk on Boylston Street where the first bomb went off near the finish line. Globe staff photo by John Tlumacki (metro)
Boston04/21/14- At the Boston Marathon at the finish line ground level on Boylston Street. S. Spectators stand at the site of the first bomb as a small memorial cross sign for the victims of the 2013 Boston Marathon is tucked away next to the sidewalk on Boylston Street where the first bomb went off near the finish line. Globe staff photo by John Tlumacki (metro)
The Boston Globe

Over the last week or so, I have been preparing myself for the first anniversary of the Boston Marathon bombings. I am a resilient person, and I tend to remain grounded during challenging moments, which is fitting for a psychologist. However, in the days leading up to the anniversary, I became keenly aware of the effects of last year’s tragedy on me. This awareness led me to want to shed light on a less-discussed area of trauma: how trauma looks and is experienced by those who tend to be highly resilient.

My traumatic experience

Though I was never in any real danger last April 15th, my mind and body reacted as if I was. The attack happened during last 20 minutes of my train ride back to Boston and once I arrived, I sat in the station for 3-4 hours, immobilized. Once home, I took to my bed for the next 36 hours, crying periodically and feeling unsettled. By Thursday, I was relieved to feel “normal” again. However, this past week, I experienced disturbances in my sleep schedule and on last Tuesday morning, the anniversary itself, I struggled to “rise and shine,” feeling cranky and uneasy instead.

Advertisement - Continue Reading Below

Last year, having a reaction did not surprise me though the intensity of it did. Additionally, I did not anticipate feeling as “off” did the first anniversary of the attack arrived. This is the nature of unprocessed trauma in those who are highly resilient. You see, while I was in no real danger on April 15th, I was in real danger on September 11, 2001, and the Boston attacks triggered trauma associated with that day. Like many others, 9/11 is stamped in my body as the day I thought I was going to die, forever changing me and my perception of safety in the world.

What trauma symptoms look like for more resilient people

Traumatic reactions for those who are generally more resilient tend to show up quietly but can still be quite disruptive. Unprocessed traumatic experiences can affect everyone by creating long-lasting pain, but it is the people who are highly resilient whose scars are less visible. Furthermore, because resilient people tend to “keep their cool,” often supporting others through the crisis, they may be unaware of their own needs for support in processing what has happened.

Unfortunately, even the medical community has struggled with defining the nuances of trauma symptoms beyond its early understanding as a result from war. Fortunately, the newest version of Diagnostic and Statistical Manual of Mental Disorders has done a better job in describing the symptoms of trauma, though its checklist still does not capture the subtlety of symptom presentations in the highly resilient. Therefore, I have created the following supplemental list, describing how some common nuances of trauma symptoms might be experienced someone who is more resilient, derived from my professional and personal experience with trauma:

1. The impact of the trauma may go largely unnoticed beyond the initial period of crisis for highly resilient people as they tend to “bounce back” quickly, focusing on their ability to complete tasks of everyday life.

In the days that followed 9/11, I struggled with feelings of deep fear and sadness but I measured my well-being by my ability to get my graduate school work done. In the week after the event, I was getting no work done, but within a month I started to regained my concentration, actually performing better than I had before 9/11. At that time, getting my school work done reassured me that I was “okay” so I did not think I needed any professional support in processing what I experienced though I later realized that I was affected and eventually sought treatment.

2. Highly resilient people tend to ignore or dismiss signals of distress by finding alternative, benign or more “logical” explanations.

Though I was able to get back to my normal life following 9/11, loud, surprising sounds unnerved me and I would unwittingly shrug my shoulders up and move my hand over my head as if taking cover whenever I heard the roar of low-flying airplanes.

Since the Boston Marathon bombings, I’ve had patients describe increased awareness of sirens and recently, a patient described feeling quite uneasy by the non-stop whirling of helicopters blades in the city. Instead of noting these automatic behaviors as signs of unprocessed trauma, I often made jokes to ease the discomfort or embarrassment of my reactions and I noticed my patients doing the same. Humor, one of the most common and helpful coping skill of the resilient, can also foster distraction from exploring distress more deeply.

3. Resilient people may avoid reminders and observances of the event.

For 2-3 months following the Boston Marathon bombings, I unknowingly avoided the Copley area as much as possible. Once I did return to patronizing that area, I became aware of how upsetting the memorials and the boarded up windows in the epicenter of the attack were for me. This year, several of my patients have indicated that they are not planning on attending the marathon, or have decided to get out of town despite previously looking forward to the event. Further, two of my patients actually “forgot” about the approaching anniversary and marathon despite the plethora of “Strong” memorabilia throughout the city.

4. Highly resilient people tend to avoid thinking about or talking about the traumatic events, but they experience disruptive symptoms affecting normal life routines regardless.

In the week around the first anniversary, I noticed small, incremental pushbacks in the time I went to bed and I felt uncharacteristically impatient, irritable, and less sociable. I did not have nightmares, rage, tearfulness, or other “classically” identified trauma symptoms, but I could tell that I felt “off” and not quite “like myself.”

Also in the last week, several of my patients described feeling down for seemingly “no reason.” However, after exploring the impending anniversary as a factor, some of them recalled that while they were not afraid last year, they did feel more vulnerable, lonely, yearning for more meaningful connections and seeking social contact, which is a common by-product of collective trauma. Therefore, as the anniversary approached, similar feelings of vulnerability and loneliness were likely triggered unconsciously, leaving them feeling a bit “blue or down.”

If the list sounds like someone you know...

If you think you know a person who you think may have been triggered by the anniversary of the bombings, reach out to them and ask how they are feeling. Reflect that it makes sense if they might be feeling a bit “off...down...not themselves” these days. Validating someone in this way helps normalize a resilient person’s experience of trauma, which they may not even be aware of experiencing. With increase awareness, it is more likely that they will seek and engage in supportive activities.

If the list sounds like you...

For those people who the list fits, recognize that while your resiliency is an asset, you do not have to go through the healing process alone. Share your story and feelings with loved ones. Find ways to observe the anniversary of the bombings and consider seeking professional support, either via recovery groups or individual psychotherapy. The effects of unprocessed trauma stick around and can create powerful disruptions so seeking supportive intervention as close to the event as possible is best, and a year out is just as good of time as any to do important work of healing and creating more peace for our community and ourselves.

Dr. O’Neal is a Harvard-trained, licensed clinical psychologist with a diverse clinical background. She has worked with children, adolescents, adults, and geriatric patients, accumulating more than 13 years of direct clinical experience. She currently maintains a private practice in the Back Bay in Boston where she specializes in treating adults with anxiety, depression, body image disorders, trauma, and relationship challenges to name a few. A member of Harvard Medical School’s clinical faculty, Dr. O’Neal previously served four years as a staff psychologist with Harvard University’s Health Services.