Üsküdar Üniversitesi Founding Rector, Psychiatrist Prof. Dr. Nevzat Tarhan, participated as a speaker in the “Post-Traumatic Stress Disorder” workshop organized by Şehit İlhan Varank Science High School. Emphasizing the importance of being able to continue life by learning from trauma, Tarhan said; “Someone who does not lose hope can easily emerge from trauma, even learning from it. In trauma, we try to teach this life philosophy; ‘Live today, learn from the past, but look to the future.’ If we have this perspective, we ask ourselves what these events taught us. We shape our future accordingly and learn from the past, but we do not live in the past.”
“Post-traumatic stress disorder diagnosis emerged after the Vietnam War”
Tarhan made statements about the emergence of post-traumatic stress disorder and some symptoms effective in its diagnosis, addressing the differences between this disorder and anxiety disorders. Tarhan said; “Post-traumatic stress disorder was a previously known illness, but it was known as anxiety disorders. It gained attention as a separate clinical diagnosis after the Vietnam War in 1980. The definition matured, and its neuropathological correlates in the brain were later found. Consequently, it was accepted not just as one of the anxiety disorders, but as a separate clinical case and diagnosis. And indeed, the same clinical picture is very frequently experienced in individuals who undergo very severe trauma. There is acute stress disorder and also post-traumatic stress disorder. Acute stress disorder does not occur in everyone; it happens in some individuals where the person experiences an immense sense of dread at the first moment due to the shock effect of stress. When a person feels their psychological integrity is disrupted, they experience intense fear and dread. While experiencing this, there is the hypothalamus region in the brain. It is the region in the middle of the brain that manages the autonomic nervous system. That area is overstimulated, and when stimulated in such situations, the brain secretes excessive stress hormones. When stress hormones are secreted, in acute stress disorder, just as we cannot move our arm due to pain when it's broken, the brain also blocks itself during that acute stress. There are people who stare blankly, as if the body is here and the soul is elsewhere.”
“There are three main symptoms related to the brain’s excessive stress hormone secretion”
Tarhan, referring to the three main symptoms of the brain's excessive stress hormone secretion, stated; “When acute shock, which is one of the symptoms of post-traumatic stress disorder, is experienced, the neural circuits in the brain malfunction. The connection between the brain region that produces words and the brain region that adds meaning and emotion to words is severed. The person is afraid, thinks, but cannot express themselves, meaning they are blocked. Or, if they are severely blocked, as seen in some scenes after the earthquakes, they wander around aimlessly with bread in their hand. Because they experience such dread that the brain protects itself and becomes blocked. There are three main symptoms related to the brain’s excessive stress hormone secretion. First; the person experiences an event where they feel shock and terror. Second, 50 out of 60 minutes are spent thinking about the same thing. They close their eyes, constantly thinking about that event, even becoming unable to think or talk about anything else. There are people who are afraid to sleep, saying they dream about this event, and don't sleep to avoid the dream. Then there is what we call 'flashback' or re-experiencing, where the person relives the event as if it happened just one day ago. Furthermore, avoidance behaviors occur later. They avoid talking about this topic or listening to news related to it. If there is avoidance behavior, it means post-traumatic stress disorder has started. This is generally considered natural within 4 to 8 weeks. We do not consider this an illness, so we do not administer medication.”
“Unresolved trauma can turn into 'complicated grief'”
Tarhan emphasized the importance of resolving traumas, highlighting that unresolved traumas can turn into complicated grief. Tarhan said; “Post-traumatic stress disorder begins to become dangerous after 6 weeks. If a person is still experiencing the intensity of the event in the same way after approximately 6 weeks, clinical treatment is required. It is a treatable condition, but sensitivity varies depending on the personality structure of some individuals. Even if some people forget the event, the brain does not forget. When a reminder emerges later, they can suddenly experience the same thing. Post-traumatic stress disorders are major terrifying and frightening events. Out-of-the-ordinary situations such as earthquakes, disasters, sexual assaults, and sexual violence are considered trauma. During trauma, making the person feel that they are not alone is sufficient support for them. It is similar at funerals when loved ones are lost. Traumas need to be turned into resolved trauma; if they remain unresolved, it is called 'complicated grief'. The person cannot resolve the complicated grief. Because they cannot resolve the grief, it becomes unresolved grief, turning into a constantly bleeding wound. In trauma treatment, we transform unresolved trauma into resolved trauma. We place the trauma within a logical framework. Then we put it on a shelf, we don't say 'forget'. People tend to mummify trauma, living it as if it happened yesterday even a year later. Instead, that trauma needs to be minimized, miniaturized, turned into a memory, and the memory of the lost person kept alive. If this is done, the trauma becomes resolved trauma. If you completely ignore it, that also becomes complicated trauma. For this reason, being unable to resolve grief significantly affects a person's mental health. There is even a parallel to this in social psychology; for example, there is a famous psychiatrist in America, Professor Volkan, who has a good observation. He says that Turkey could not resolve the trauma of transitioning from the Ottoman Empire to the Republic, this grief. Because it could not resolve it, it continues to experience identity confusion today.”
“After trauma; live today, learn from the past, but look to the future”
Tarhan expressed the philosophy of life they teach to those who have experienced trauma as; ‘Live today, learn from the past, but look to the future,’ and emphasized the importance of emerging from trauma by learning from it with this method. Tarhan said; “Every danger has a threat dimension and an opportunity dimension. Trauma is a threat. An earthquake is a danger. Fifty thousand people died; this is the threat dimension. But there is also an opportunity dimension. The opportunity dimension is, for example, nearly 20 thousand people died in the İzmit earthquake. However, the gross national product of the Kocaeli region has increased more than the general standard of Turkey compared to 20 years ago. This means that the people in that region experienced trauma, and then, under the influence of the trauma, they worked harder. We call this post-traumatic growth. More development occurs. I think the same applies to the Kahramanmaraş-centered earthquake. If we take the right position, if we utilize the opportunity dimension, those areas will be rebuilt more beautifully. Something better will emerge, but for the losses, fire burns where it falls. For those who have lost a first-degree relative, the most important thing in such situations is not to lose hope. Someone who does not lose hope can easily emerge from trauma. They even emerge learning from it. In trauma, we try to teach this life philosophy; ‘Live today, learn from the past, but look to the future.’ If we have this perspective, we ask what these events taught us. We shape our future accordingly and learn from the past, but we do not live in the past. If you live in the past, the trauma continues, but if you learn from the past and look forward, there is a post-traumatic growth scale. On this scale, the person becomes more mature, wiser, and gains resilience training after trauma. Their psychological defenses strengthen. When you look at the person after trauma, a stronger personality emerges.”
“Stockholm syndrome is seen in individuals with attachment disorder”
Tarhan also made evaluations regarding attachment styles, stating that parents must be very careful for attachment to be established correctly from infancy. Tarhan said; “Stockholm syndrome can occur in individuals with attachment disorder during trauma. There are three main personalities in attachment styles. One of these is personalities who cannot empathize, which we call the second axis, and the other is personalities with attachment disorder. These individuals cannot form secure attachments. In this respect, it is anxious attachment. The object of attachment is also the most important thing in a person's life. Because humans are relational beings. They are not programmed to live alone. It is so by creation. Because of this, humans need attachment. For example, there is the attachment hormone oxytocin. Oxytocin is most secreted in breastfeeding mothers. Neither the breastfeeding mother nor the child leaves each other. Individuals with attachment disorder cannot separate from the object of love, cannot individuate. As the child grows and begins to walk, they will feel both a sense of belonging to the home and family, and a sense of freedom in the object of love; this is the balance. We often cannot achieve this balance. We will feel both belonging to the family and free. Stockholm Syndrome occurs in individuals with attachment disorder.”
“We provide training to prevent post-traumatic stress disorder”
Tarhan emphasized that individuals should be provided with training on trauma psychology to prevent stress disorder after a trauma occurs, and spoke about the importance of primary and secondary prevention before trauma. Tarhan said; “Anxiety disorder is often confused with depression. They have certain specific symptoms, but generally, in post-traumatic stress disorder, there is a clear trauma. That trauma also has a causal relationship and a temporal relationship. Even if the same symptoms are present in someone else, if these two characteristics are absent, and it started after a trauma and has a time dimension, then it can be two. In that case, it can be post-traumatic stress disorder. We can also find similar symptoms in other illnesses, so it is important to have a causal relationship with the event. Those traumas then appear to be resolved. We provide training on trauma psychology to individuals to prevent stress disorder after trauma occurs. Primary and secondary prevention are carried out before trauma. Post-trauma protection, which is tertiary protection, and primary and secondary protection, involve teaching a person in a healthy society, who has no trauma, what to do if trauma occurs. Just as disaster kits and the triangle of life are important in disasters; those who receive this training can apply it immediately during trauma. The Japanese are constantly providing this training. Similarly, post-trauma training should be taught this way. Individuals with psychological resilience cope with trauma more quickly.”
“Individuals with good psychological resilience cope better with trauma”
Tarhan drew attention to the importance of pre-trauma resilience training for society; “There is a method called EMDR in trauma treatment. The absence of trauma, which is what we call resilience training, meaning embracing hardship, helps individuals with good psychological resilience cope better with trauma, but no matter what you do, there will always be individuals in society who are vulnerable to trauma. For this, there is even a stress management method. In stress management, there are 3 types of people: sponge people who absorb stress. They are constantly complaining, whiny, and you constantly listen to their troubles. Then there are Teflon people. Teflon people appear insensitive, carefree. Like a Teflon pan itself doesn't burn, but it burns what touches it. These people protect themselves at that moment. You might say they were not affected by the trauma at all, but these people end up alone because they are careless and insensitive, cannot empathize, and do not help anyone. They seem temporarily relieved, but in the medium to long term, they become lonely because they are selfish and opportunistic. Most of those who remain alone in old age are like this; if they have power, they are not alone, but when they lose power, Teflon people are left like a stalk. But the ideal people, who are trauma-resilient, are rubber people. In rubber stress management, rubber stretches and then returns to its original state; in psychological terms, people with psychological resilience return to their original state after experiencing trauma. They emerge from trauma having learned something and become stronger.”