Vulnerability to PTSD
Some people recover remarkably from the most harrowing experiences while others take much longer to ‘bounce back’ from extreme experiences, if they indeed ever recover fully. Regarding the roots of vulnerability, Chappell (2003:83) identifies them to be the family life history and parental conditioning. He also believes that vulnerability and causation each need the other to exist, but that no particular one precedes the other. In Chappell’s words (2003:83): “Vulnerability and causation … are the tools of the irritation and pain that create suffering, crisis, and the possibility of consciousness-raising, apparently the main purpose of life.” Researchers have singled out certain predictors and risk factors for the development of PTSD.
According to various authors, including Van der Kolk, Van der Hart and Marmar (1996:311) and McFarlane and Yehuda (1996:175), dissociation at the time of the trauma increases an individual’s chances of developing PTSD. Dissociation is such an important concept in the discussion of trauma that section 3.8 is devoted to a discussion thereof. If dissociation can be resolved, the probability for a positive outcome is greatly elevated. Levine (1997:99-100) is of the opinion that trauma (as a result of painful experience, see Corsini’s definition quoted in section 3.1) will not occur, provided the person (or animal) can respond in a way such as fleeing or defending itself, discharging energy and resolving the threat. However, the authors quoted inthis study all show that threats are often not resolved and that this causes the problems discussed.
Scaer (2005:262) identifies prior childhood trauma as the most important predictor of dissociation when confronted with subsequent life trauma. Not only are these individuals’ chances of developing problems elevated, but their prognosis may also be affected. Luxenberg et al. (2001:382) found low scores on early childhood measures of competence and/or safety and the presence of multiple forms of trauma during early childhood to be indicative of a poor prognosis. The researcher believes that Scaer’s (2005:262) observation is of critical importance: “The very factors that tend to determine whether a person is likely to be traumatized by a specific event are those that also predispose the victim to tendencies to dissociate in the first place.”
Levine (1997:18) states that people are vulnerable to the effects of trauma since they have genetic memory of being easy prey. Major trauma experienced in a previous generation could also increase the following generation’s vulnerability to trauma. Yehuda et al. (1997) conclude that the children of Holocaust survivors may be psychologically and ‘biologically’ vulnerable to stress and trauma. Paul (1997) quotes Rachel Yehuda explaining that “‘[w]e don’t walk into trauma equally, so we don’t all come out of it equally.’” Other risk factors singled out in the same article are previous trauma, childhood abuse and a family history of alcoholism and depression.
Conclusions to the research by Liebschutz (2006:47) include that trauma and PTSD in primary care are associated with substance misuse and pain. Studies in progress by researchers at Kent State University Department of Psychology (2008) are based on previous pilot work that found a negative correlation between (elevated) levels of cortisol during motor vehicle accidents and the development of PTSD, and positive correlation between (elevated) levels of norepiniphrine and the development of PTSD. The cortisol connection had previously been researched by Yehuda, Southwick, Nussbaum, Wahby, Giller and Mason (1990). They found a correlation between low cortisol levels and the development of PTSD. It is predicted that there may come a time when a blood test can indicate who is at greater risk and needs specific treatment (Paul 1997). Although they concluded that low cortisol levels are associated with clinically significant PTSD symptoms, Yehuda et al. (1997) do not draw any links to its similar nature to Adrenal Fatigue Syndrome (AFS), as described by Wilson (2001). While one of the prime symptoms of AFS is lowered cortisol levels, the most important cause is chronic stress (Wilson 2001:48). Identifying a symptom of PTSD has merit, but it may be equally important to consider natural explanations for lowered levels of cortisol, such as Wilson’s research on and conclusions about the functioning of the adrenal glands.
If the correct measures are taken immediately following trauma, including cognitive-behavioural intervention (Psychology Today 2006) and other therapeutic interventions, the chances of developing PTSD are reduced. However, according to Levine (2006), the longer the period that elapses between ‘traumatic activation’ and the resolution thereof, the longer the recovery period becomes. Levine’s work (1997:101,103,105) places great importance on the resolution of the immobility response by discharge of the frozen energy accumulated during the traumatic response. He holds the opinion that a person will be traumatized when the neo-cortex overrides the instinctual completion of the immobility response, interrupting or preventing the trembling discharge from completing the cycle. In his view, if this cycle is properly facilitated and correct techniques for emotional and energetic support are offered in the immediate aftermath of trauma, as he describes (Levine 2005:83-90), PTSD will not develop. It follows that the indiscriminate use of medication to suppress reactions in the immediate aftermath of traumatic events may also interfere with the completion of the very response cycle that is so important to prevent development of long-term adverse symptoms.
Vulnerability can also include the possibility of subsequent future events triggering traumatic reactions. While Kandel (2006:342-3) points out that fear can easily become associated with neutral stimuli through learning, he explains that such learned fear, which he also associates with PTSD, can easily be reactivated by various stressful circumstances. With repeated exposure to even little traumas or the witnessing of apparently everyday forms of violence, resilience can be overpowered and people can manifest symptoms of PTSD. In her book Common Shock:
Witnessing Violence Every Day Weingarten (2003) particularly highlights at length the influence of such accumulated experience, including secondary traumatization caused by witnessing of even minor forms of violence.
Effects of trauma
A discussion about trauma is not complete without mentioning Sigmund Freud’s work. Although knowledge on the subject has expanded greatly since Freud’s time, he played a key role in framing ideas in the first place. Freud (1939:76) observed that trauma and the reactions to trauma have a great psychical intensity, that the effects of trauma can result in an organization within the mind independent of other mental processes, and that the possibility of psychoses exists when psychical reality takes precedence over external reality. These are all possible effects of trauma that can present in cases of particularly severe trauma or in individuals with vulnerabilities.
However, fortunately most individuals have adequate resilience, support structures and coping mechanisms protecting them from developing such devastating symptoms. It is still likely that traumatized individuals will be affected by symptoms, perhaps less severe than those mentioned above, but still warranting detection, explanation and treatment.
Regardless of possible pathological manifestations and effects that can be categorized as illnesses, the most direct and immediate effect of trauma is a drain on the energy the musician has available for other tasks. Watkins (2005:2-8) explains at length how great amounts of ‘self energy’ are needed by artists in their professional capacity. He also classifies ‘self energy’ as an expendable commodity. Therefore it can be deduced that the extent of the toll any particular trauma takes on the available energy of the musician is directly related to a decrease in creative output. In addition, Montello (2002:202) describes that in cases of severe childhood abuse, a child subpersonality becomes frozen at the age when the primary trauma occurred. She declares that the core self is still always present, but that a great amount of psychic energy is required to deal with the unfulfilled needs of so-called subpersonality(ies). Montello describes this drain of energy and identifies awareness as an essential component of the healing process (2002:203): Ideally, this same energy could be used more productively in facilitating creative growth and change, but instead, the subpersonalities, which are typically fear based, resist change and keep you centered in survival mode … The way to harmonize and integrate these fragments into a whole is to first become aware of who they are and when they are throwing you off balance; and second, to find a way for your core self to lovingly communicate with these subpersonalities and get them on the same page with respect to your mission in life.
It can be concluded from the explanations of Watkins (2005) and Montello (2002) that trauma drains our energy. As will be seen in the remainder of this section, other authors also refer to the effect trauma has on energy, described in different ways such as ‘frozen energy’ of the immobility response (Levine 1997:99-100), energy released in order to prepare for fight or flight, and the release of energy when we heal from trauma (see the quotation from Levine’s work at the beginning of this chapter, p 47).
Sutton (2002:24) explains the series of processes that trauma starts as follows: “Trauma does not occur due to the external factor of a single event. Trauma is enmeshed in an external process of an attempt to assimilate how the event has irrevocably affected the individual.” She also explains that what traumatizes the individual in such a situation is the loss of the ability to experience, act on and re-experience one’s own influence, since the person is controlled by an event happening to him or her (Sutton 2002:31). Unfortunately, according to Jensen (1998:58-9), these effects of loss of control can be so powerful as to rewire the brain and result in learned helplessness. He also states that if the victim was able to make choices and act upon those during a traumatic situation, regardless of its outcome, learned helplessness would not occur in the aftermath.
Nancy Coles, the clinical director of the centre where pianist Linda Cutting received treatment for traumatic response to incest during her childhood, illustrated trauma by drawing a black hole.
Cutting (1997:73) quotes Coles as having said in a lecture on trauma theory at the abovementioned treatment centre: “It’s intrusive, unpredictable, creates a state of helplessness, and disrupts homeostasis. Trauma affects everything – even one’s balance”.
CHAPTER 1: BACKGROUND
1.1 Motivation for the study
1.2 Theoretical framework
1.4 Research questions
1.5 Aims of the study
1.6 Research method
1.7 Delimitation of the study
1.8 Value of the study
1.9 Discussion of contents
1.10 Literature overview
1.11 Notes to the reader
CHAPTER 2: EMOTION AND MEMORY
2.1 Introduction to the relationship between emotion and memory
2.2 Defining emotion
2.3 Biological basis of emotions
2.4 Emotion and motivation
2.5 Expression and perception of emotion in music performance and appreciation
2.6 Defining memory
2.7 Types of memory
2.8 Emotion, memory and trauma
2.9 Performance from memory and stage fright
CHAPTER 3: TRAUMA
3.1 Defining trauma
3.2 Types and dynamics of trauma
3.3 Acute Stress Disorder
3.4 Post-traumatic Stress Disorder
3.5 Vulnerability to PTSD
3.6 Effects of trauma
3.8 Treatment of trauma symptoms
3.9 Alternative viewpoints regarding treatment of trauma
CHAPTER 4: TRAUMA AND MUSIC
4.1 Psychological aspects of music performance
4.2 The effects of trauma on musicians
4.3 The influence of past trauma on famous musicians
4.4 The use of music and art in the recovery process after trauma
4.5 Responsibilities of music teachers regarding witnessing and referring
CHAPTER 5: RESEARCH METHODOLOGY
5.2 Research design
5.3 Qualitative psychological research
5.6 Ethical considerations
CHAPTER 6: OUTCOMES OF THE RESEARCH SURVEY
6.1 Opinions of participant healthcare professionals
6.2 Opinions of participant music teachers
6.3 Self-reports of trauma experienced by teachers
6.4 Case studies
CHAPTER 7: RESEARCH FINDINGS
7.1 Observations emerging from the research survey
7.2 Aspects relevant to self-reports of teachers
7.3 Observations emerging from the case study investigations
7.4 General observations applicable to the research survey and case studies
7.5 Comparison of research findings to literature on trauma
CHAPTER 8: CONCLUSIONS AND RECOMMENDATIONS
8.1 Answering the research questions
8.2 Proving or disproving the hypotheses
8.4 Recommendations for further study
8.5 Recommendations regarding areas that should be implemented in the training of music educators
List of References