The International Journal of Psychosocial Rehabilitation
Hope and Meaning During Times of Tragedy and Loss:

Appreciating the Influence of Meaning in the Aftermath of Trauma

 

Jo-Ann Vis
Keith Brownlee

School of Social Work
 
Lakehead University

 

 Citation:
Vis J & Brownlee, K. (2008). Hope and Meaning During Times of Tragedy and Loss: Appreciating the Influence
of Meaning in the Aftermath of Trauma
.
  International Journal of Psychosocial Rehabilitation. 13(1), 39-49

 

Address correspondence to
Dr. Keith Brownlee,
School of Social Work
 Lakehead University
955 Oliver Rd.
Thunder Bay, Ontario, Canada
P7B 5E1
                       
E-Mail: kbrownle@lakeheadu.ca
  

Abstract  
Throughout history accounts have been given of the physiological, psychological and spiritual effects of traumatic incidents. However, fully understanding the impact of trauma in a way that leads to effective intervention or treatment continues to be a challenge. This paper explores recent literature and scientific research in the area and argues in favour of a post-modern perspective of trauma. A therapeutic approach consistent with this perspective is presented that not only incorporates the complexity and individuality that a trauma experience entails, but also addresses the possibility of moving beyond the tragedy of the traumatic experience.
 

 Introduction
            Susan, a mother of three, accessed counselling following the death of her youngest son, Shawn. Shawn was 12 years old when he took his own life. Susan and her family lived in a small rural community, where her children attended the community’s public school, engaged in after-school activities such as hockey, and interacted with many friends and family. According to Susan, they lived a “normal, regular, everyday type of life”. Susan and her husband, Bob, both had full time jobs, and as part of their daily family routine, one parent would go home during the lunch hour to meet the children and get things ready for their evening activities. On the day when Susan came home to meet her son for lunch she found him lying on their living room sofa with a gunshot wound to his head. How does one move on after such a truly traumatic event? 

            Many theories dealing with the impact of trauma focus on long term traumatic experiences, such as childhood sexual and physical abuse, or they focus on large-scale traumatic events such as war, plane crashes, school shootings, and other significant events that attract media attention (Bell, 1995; Herman, 1992; McCann & Pearlman, 1990; Mitchell & Everly, 1994; Terr, 1983; van der Kolk, McFarlane & Weisaeth, 1996). The theories and models developed to contribute to our understanding of how to assist victims of large-scale traumatic events do also provide direction for responding to individuals such as Susan. However, while this information is significant, and has assisted in adding to the knowledge concerning trauma, the attention to individual, short term (acute) trauma events such as Susan’s is equally important.

Personal testimonies such as Susan’s have led to the professional literature recognizing that trauma is a multifaceted phenomenon. The research on trauma has also supported the position that people who have been exposed to trauma experience a variety of after-effects (Courtois, 1988; Herman, 1992; LeDoux, 1994; McCann & Pearlman, 1990; Neimeyer & Stewart, 1996; Schultz, 1998). This information has extended our understanding beyond traditionally accepted views of trauma and introduced new possibilities for trauma management. It has served to highlight how each individual’s response, understanding, or truth regarding the traumatic event is unique. Thus, practitioners have been challenged to consider interventions that support this uniqueness in ways that offered multiple views of a traumatic incident (Franklin, 1995; Hoffman, 1990; McCann & Pearlman, 1990; Neimeyer & Stewart, 1996).

            The purpose of this paper is to explore recent research and ideas about trauma recovery, and to identify key concepts that influence memory, mood, behaviour and, ultimately, post-trauma management. The case is made that acute trauma involves an integrated process, which incorporates physiological, sensory, and socially constructed experiences. The paper begins with a summary of the literature defining traumatic events followed by an examination of recent research on memory and a discussion of the integrated model of memory formation. It is argued that these emerging ideas about memory formation support a post-modern perspective of trauma and challenge traditional conceptions of how to best respond therapeutically to trauma. In conclusion, this paper will present a therapeutic approach to trauma that not only incorporates the complexity and individuality that a trauma experience entails, but also one that provides possibilities to move beyond the tragedy of the traumatic experience. It is an approach that challenges individuals and therapists alike to see trauma as more than tragedy, loss, and victimization and to include hope and personal strength.

 

How Trauma has Been Defined

            Throughout history, there have been numerous accounts and descriptions of events and circumstances related to trauma (Keane, Marshall, &­ Taft, 2006). The majority of recorded and researched events in areas of trauma have either been linked to times of war (Archibald & Tuddenham, 1965; Frankl, 1984; Horowitz & Solomon, 1975; Kutchins & Kirk, 1997) or connected to the trauma associated with child abuse (Courtois, 1988; Herman, 1992; McCann & Pearlman, 1990; van der Kolk et al., 1996). Although the research and theoretical knowledge in these two areas have increased our awareness of and response to trauma victims, a situation has emerged whereby attention has been concentrated on the similarities of trauma experiences while tending to overshadow the differences between these experiences. Consequently, trauma has been defined broadly to encompass the variety of circumstances (Kutchins & Kirk, 1997; McCann & Pearlman, 1990).

            McCann and Pearlman (1990), for example, define an experience as traumatic, “if it (1) is sudden, unexpected, or non normative, (2) exceeds the individual’s perceived ability to meet its demands, and (3) disrupts the individual’s frame of reference and other central psychological needs and related schemas” (p.10). The most frequently used definition of trauma is post traumatic stress disorder, or PTSD. The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR, 2000) describes a broad range of events that have been experienced directly, witnessed or even learned about as likely to be traumatic such as, “actual or threatened death or serious injury, or other threat to one’s physical integrity” (p. 467). The DSM-IV-TR focus is on the characteristic symptom response rather than on the event itself. These symptoms may include reactions of intense fear, helplessness or horror that are persistent and which are associated with further reactions such as increased arousal, temper outbursts, difficulties falling asleep and numbing and avoidance of stimuli associated with the event.

            The argument that there are similarities in the way people experience the effects of trauma is irrefutable; yet, the differences also need to be considered as these differences give rise to the distinctiveness in the experience of trauma. For example, in its simplest terms, war can be seen as an event that pits one side against the other, the other being a non-personal association with “the enemy.” Political forces beyond individuals’ control require them to serve their country, providing a socially constructed meaning or purpose for those who have been “recruited for this task.” Experiencing the trauma with a group of peers significantly impacts the meaning that is derived through conversations with others in the group as all members are exposed to the same level of atrocities and grapple with forming a future outlook (Archibald & Tuddenham, 1965; Golan, 1978; Horowitz & Solomon, 1975; Kutchins & Kirk, 1997; Mott, 1919). Survivors of war related trauma stand in sharp contrast to a childhood abuse survivor, who sustained ongoing trauma at the hands of a knowing perpetrator of the trauma. The child abuse survivor often has no one with whom to share language or experience, and is left alone in silence to manage the trauma with little hope or promise of an end or victory (Courtois, 1988; McCann & Pearlman, 1990; Herman, 1992; van der Kolk et al., 1996). In further contrast, are those individuals who have been exposed to a traumatic event without warning. This type of trauma is sudden, unexplainable, and perhaps even short lived. They may not have any means of understanding why the event happened; experience confusion as to their role in the event; and they may even question the validity of allowing themselves to think about the impact, believing that they should just forget about the whole thing and move on. The presence of these and other contrasting trauma experiences adds weight to the argument that there is a need to account for the differences in trauma experiences.

             Research on trauma experiences suggests that a variety of factors such as emotional responses, implicit and explicit memory, sensory factors, suggestibility, narratives, long-term exposure to trauma and post trauma experiences all influence memory outcomes. Thus, the question is whether the physiological, physical, emotional and spiritual self is affected in the same way, regardless of the type of trauma experienced. In this paper, our focus is on acute single trauma events rather than trauma which is long term, developmental, or involves mass or world wide destruction, such as war. Trauma here will be taken as all single, non-normative unexpected events, which have life threatening or life altering implications, and go beyond one’s perceived ability to meet its demands. This experience would be seen as having the ability to disrupt the individual’s frame of reference and understanding of his or her world as he or she views it. The following section discusses the significance of individual integration processes that incorporate physiological, sensory, socially and spiritually constructed experiences.
 
  The Memory-Meaning Connection
             Before the effects of trauma can truly be appreciated, it is important to understand how memory of an event can influence emotion and, subsequently, the ability to cope and manage. Most people believe that a memory is an accurate account of actual events, that our memories are solid and can withstand any outside influence or persuasion. When we think back to events, we imagine descriptions, sensory images and outcome, played back in the manner of a movie projector, giving us a vivid and reliable recollection of those events. Unfortunately, our mind’s reconstructed “truth” may not be accurate at all.

            Research has begun to challenge many established theories of memory formation and retrieval. Memory is now believed to be influenced by a complex set of circumstances before, during and after an event. Memory, as we have come to understand it, can be constructed through our sensory, working, and subjective memory.

            McCann and Pearlman (1990) discuss the interconnection between memory and perception. They propose that the verbal, imagery, affective, somatic and interpersonal experiences inform perception and that perception subsequently informs memory. McCann and Pearlman argue that all of these components are necessary for full perception, which then leads to a complete memory. While this information was provided in attempts to understand memory perception for adult survivors of childhood abuse, one could see the potential for connections between this and other trauma circumstances. It could be argued, therefore, that individuals develop a unique sense of a traumatic event, which is vulnerable and susceptible to suggestibility.

            Schacter, in his work Searching for Memory (1996), discussed research by Charles Wilkinson (1987), who investigated 102 survivors of a traumatic incident in 1987 in which two skywalks connected to the Hyatt Regency Hotel collapsed. This disaster ended with 114 deaths and more than 200 physical injuries. In his research, Wilkinson discovered that nearly 90 percent of these people said that they had repeated memories of the event. These memories were intrusive and disrupted the daily life functioning of many. Within these memories were associated emotions of sadness, anxiety, depression, and even detachment. Wilkinson reported that since the event nearly one in three experienced “memory difficulties.”

            Nearly all scientific research in the area of trauma suggests that trauma events can have long-lasting impact. This impact not only has to do with the event itself, but the emotions these memories induce later. These memories are not only connected to the recall of events, but also influence the interpretation that elicits the emotions and meaning of the event itself. Schacter (1996) suggests that memory of trauma events are not devoid of emotion; in fact, the two may be inseparable and he coined the term “emotionally traumatic memories” to describe this phenomenon. Regardless of the debates defining trauma, there appears to be agreement that overwhelming emotional responses to a traumatic incident disrupt the usual processing of memory and affects emotion and behaviour (Butler, 1996; LeDoux, 1998; Ratey, 2001; Schacter, 1996; 2001).

            We no longer view memory as developing in isolation (Koriat, Goldsmith, &­ Pansky, 2000; Mazzoni, & Vannucci, 2007). Similar to a strand of fabric woven within a sheet of cloth, memory connects and interweaves with other threads such as perception, meaning, emotion, and mood (Richards, Butler, & Gross, 2003). As a result, memory is not a simple video tape playback system of the concrete movements and actions related to a particular event; rather, each movement and action is interpreted, and this interpretation feeds into the emotions associated with the event (Bonanno, Papa, O’Neill, Westphal, & Coifman, 2004; Richards & Gross, 1999; Laney, Campbell, Heuer, & Reisberg,  2004; Levine, 1997; Levine, & Pizarro, 2004).

            Research is unearthing significant ties between memory and emotions or mood. Schacter (1996) credits Mark Williams and his colleagues as the first individuals to report that emotions can bias perception and memory. Williams’ research compared two groups, one in which people reported depression type symptoms, and another in which no such symptoms were reported. They found that the group with depressive mood symptoms would focus on generally negative experiences more than their counter parts: “They tend to encode (and therefore retrieve) everyday episodes through a negative filter that confers a kind of repetitive and pervasive drabness on all their experiences” (Ratey, 2001, p.211).

Even non depressed people report that sad moods tend to feed on themselves: when you feel sad, it somehow seems all too easy to think negative thoughts and remember painful experiences. Psychologists have a name for this common experience: mood-congruent retrieval. Experiments have shown that sad moods make it easier to remember negative experiences, like failure and rejection, whereas happy moods make it easier to remember pleasant experiences, like success and acceptance (Schacter, 1996, p. 211).

           Thus, mood is believed to have the capacity to elicit a memory, and subsequently a memory can elicit a mood. When emotionally charged memories, such as those associated with trauma are evoked, “mood” has the capacity to influence the memory as negative, overwhelming, and unmanageable. It can be concluded, therefore, that how trauma has been perceived, how an individual makes meaning of the event, and how he or she processes the physiological and sensory aftermath of the trauma has a great impact on how an individual will navigate the trauma process. Given the significance of meaning formation during trauma recovery, it is vital that meaning exploration be a part of effective intervention.

 

 Implications for Intervention
           What has been relatively overlooked in the trauma research and literature is the post-trauma development of emotions. Why do some people cope with a traumatic event in a way that adds depth, resiliency and new meaning to life, while others continue to struggle, emotionally paralyzed with depression, anxiety, and phobias? Historically, trauma therapy has consisted of a reactionary process focusing on emotions and behaviour that become defined as stagnate (Kutchins & Kirk, 1997). LeDoux (1998) notes that historically two types of therapeutic responses have been developed to assist people who have experienced trauma:  
 
 
 Freud’s psychoanalytic theory and the various conditioning theories all assume that anxiety is the result of traumatic learning experiences that foster the establishment of anxiety-producing long-term memories. In this sense, psychoanalytic and conditioning theories have drawn similar conclusions about the origins of anxiety. However, the two kinds of theories lead to different therapeutic approaches. Psychoanalyses seeks to help make the patient conscious of the origins of inner conflict, whereas behaviour therapy, the name given to therapies inspired by conditioning theories, tries to rid the person of the symptoms of anxiety, often through various forms of extinction therapy (p. 263).

          More recently, a third therapeutic intervention has been proposed  that draws upon the current research on memory and emotions and includes the phenomenon of meaning associated with the trauma event. Meaning, or the construction of meaning making of the traumatic event, has the potential to shape our perception of the event, and subsequently influence memory, emotions, and behaviour (McCann & Pearlman, 1990; Neimeyer & Stewart, 1996). Taking the opportunity to create a space for the importance of meaning through the process of developing a narrative provides a previously unexplored, but newly emerging, interventive approach to PTSD.

            Neimeyer & Stewart (1996) explore an additional concept to trauma impact that includes the story, narrative, or belief about the role which an individual places him or herself in during and following the traumatic event. This theory adds to the complexity involved with trauma: it includes not only the trauma event itself, but the incidents following the event and incorporates the idea of people having many different selves.

As an essential part of the person, the traumatic self constrains the other possible selves. That is, as long as the traumatic self exists in its original form, the cognitive, perceptual, and emotional processes invoked during its creation place limits on psychological processes available to the pre morbid selves (Klion & Pfenninger, in press). The narrative, meaning-making processes of the former selves become more like those of the traumatic self. Subjectively, a trauma victim may feel as if “I’m not the person I once was (Neimeyer & Stewart, 1996).

            These authors conclude that roles such as “victim,” “injured,” and/or “incapable” influence the recovery process. They believe that meanings or stories that individuals develop about themselves has an impact upon their ability to move beyond the trauma experience and see themselves as something other than a trauma survivor.

            Although Neimeyer and Stewart offer valuable research and information regarding the importance of meaning, as it relates to an individual’s sense of self and how this effects an individual post trauma, the significance of meaning post trauma appears to encompass more than just self image brought on by self reflection. Rather, the formation of meaning appears to be influenced by a variety of factors, and can encompass a variety of concerns, including, but not limited to self image.

            Traumatic memories are difficult to study due to the “profoundly upsetting emotional experiences” that are often associated with PTSD (LeDoux, 1998; Ratey, 2001; Schacter, 1996). However, van der Kolk and Fisler (1995) report findings that suggest that support the idea that trauma memories are very susceptible to narrative influences. In a study of 46 subjects who were diagnosed with PTSD, van der Kolk and Fisler found that the narrative of the trauma event evolved over time. Although the sensory recall, stored as sensory fragments, may have existed since the trauma event, the narrative developed later. The authors observed their subjects constructing a narrative that explained what happened to them as they became more aware of more elements of the trauma experience, either through conversations with others, sensory experiences, or other influencing factors. The authors speculated that this “weaving of a narrative out of the disparate sensory elements of an experience is probably not dissimilar from how people construct a narrative under ordinary circumstances” (p.12). Although van der Kolk & Fisler use the term narrative as a verbal account of the description of the trauma events, their findings support the notion that memory is processed through verbal recollections, stories, and the meanings associated with them.

When people receive sensory input, they generally automatically synthesize this incoming information into narrative form, without conscious awareness of the processes that translate sensory impressions into a personal story. Our research shows that traumatic experiences initially are imprinted as sensations or feeling states that are not immediately transcribed into personal narratives, in contrast with the way people seem to process ordinary information. This failure of information processing on a symbolic level, in which it is categorized and integrated with other experiences, is at the very core of the pathology of PTSD (van der Kolk & Fisler, 1995, p.13).

Harlene Anderson (1997) and Kenneth Gergen (1999) argue that, from a social constructionist point of view, occurrences such as depression, personality disorders, and anxiety attacks are not, in fact, problematic in and of themselves. Rather, the meaning and language that we use to conceptualize our understanding of people’s behaviour develops a problem. Within this context they believe that language, dialogical interactions, and even therapy are ways in which language can be used to explore alternative truths to the traditional empirical view of problems. They propose an alternative therapeutic approach in which cause and effect realities are replaced with the challenge that the cause and effect reality is but one truth, with the emphasis being placed on the constructed meanings by which we make our way through life.

            When people think and/or talk about trauma, the initial constructed narrative about the event is about loss, suffering, inability to manage, never being able to recover from the loss. Although these narratives are true for the majority of trauma survivors, they represent but one truth. Additional narratives, looking beyond the trauma act itself, invite individuals to incorporate meaning that includes appreciation of care of others that may have been shown during the trauma event, appreciation for relationships, a chance to take what they have experienced to make a difference in their lives and how they interact with others. Of course, it is important to recognize the losses and impact that trauma may induce, and what may be experienced or learned as an outcome of the trauma experience would never make the trauma event worthwhile. But the fact that the story continues beyond the trauma events provides hope and an alterative view to suffering that trauma often entails.

            A more recent example of the power of alternative narratives can be most significantly seen following the events of September 11, 2001. Amidst horrendous trauma and loss, countless other narratives of heroism, caring, concern, and solidarity emerged beneath the rubble of the World Trade Center in New York. Almost immediately, media reports, editorials, and presidential addresses encouraged people to look beyond the tragedy. The idea that many perspectives can be held about the same phenomenon is closely related to what Gergen (1999) terms “poly-vocality”. He describes this concept as follows,

Here the major emphasis is on expanding the number of voices bearing on the problematic situation. The aim is not to locate “the solution”, or “the new story” but to generate a range of new options. With many voices at hand the deep puzzlement which the clients’ beings into therapy are replaced by a plethora of possible actions. For some therapists there is also a secondary hope: when one is exposed to many “views of the matter”, the grounds are laid for developing a consciousness of construction. One finds that “the truth of the matter,” is but “a truth”. This kind of consciousness may have the liberating implications described in the previous chapters (p.174).

            Tedeschi and Calhoun (1995), in their work on post-traumatic growth, argue that for too long research has focused on negative after-effects of trauma and has minimized individual’s ability to move past the trauma event with positive after-effects. They suggest that research needs to focus on how people move through the “process” of post-traumatic growth, believing that this understanding will offer new effective interventions in the area of trauma.

  
  Conclusion
              When Susan entered therapy, all her concentration appeared to be consumed by the memory of seeing her son’s lifeless body on their family room sofa. Through this traumatic experience she had constructed a belief (meaning) that she was a terrible mother and somehow the cause of her son’s death. Countless hours in conversation with others, reflection and reviewing police and autopsy reports were focused on the importance (meaning) in the question why. Why did this happen? Why did she not see this coming? Why did Shawn choose to suffer in silence? The answers to these questions did not appear, but instead fed the intrusive memories, the emotional responses, and the focus on Shawn’s death and how he died.

            If Susan had been offered a therapeutic approach that explored how she felt about these experiences it may have risked perpetuating Susan’s emotional reactions. Ratey (2001) and van der Kolk & Fisler (1995) support this view, noting in their research that talking about the event or the feelings about the event, once a constructed narrative has been established, does little to resolve the occurrence of flashbacks or relief from the intrusive memories. For Susan, the socially constructed narrative that she was a bad mother would only be reconfirmed if therapy continued to focus on Shawn’s death and her feelings concerning it.

            Before entering into therapy Susan had already developed a strong sense of meaning not only about the trauma associated with Shawn’s death, but her sense of self and what it would mean to live life without her son. Counselling began with Susan being asked to recount the events of the day of her son’s death. Susan was able to recall the events in detail. This process allowed for the connection of the verbal, imagery, sensory, effective, and interpersonal experiences connected to the formation of memory as discussed by McCann & Pearlman (1990). Once there was a sense that the connections were in place, Susan was then asked to think about and discuss how she has changed as a result of this trauma and what if anything has stayed the same. These questions allowed Susan to engage in conversations whereby a conscious narrative could include the possibility of shifting her established story about the event. Building on this framework, Susan was asked to elaborate on her current narrative surrounding Shawn’s death connected to meaning. It was through this conversation, using the concept of poly-vocality (Gergen, 1999), that Susan was able to discover that by continuing to focus on Shawn’s death she had forgotten about his life. She discovered that all of her conversations with anyone, following his death, related to the suicide in one form or another. Shawn’s memory was alive only in the description of his death. She realized that Shawn was not being remembered for the life he had and the joy he gave and experienced, but that this meaning or alternative truth was being overshadowed by the negative narrative of the suicide.

            By the third and forth sessions, prompted by the possibility to explore meaning beyond Shawn’s death, (Tranter & Vis, 1997), Susan began to recall stories that focused on Shawn’s life. Susan was able to discuss times when she was able to witness Shawn in laughter, having fun, and would recall how being with him brought joy to her life. Growing on this experience of alternate meaning, Susan began to be more aware of others in her life, who since Shawn’s death, wanted to find a way to pay tribute to Shawn for his athletics and friendship. Previously, Susan was unable to focus on this part of Shawn’s life, as her meaning was completely shrouded in his death. Susan was able to put away the police and autopsy reports and think about how she could use this energy to re-establish relationships with the rest of her children, knowing full well how important these relationships had become for her. Discussions around the family table expanded to include recollections of Shawn that were more than the outcome of his death.

            The traumatic incident of Shawn’s death was a reality that could not be changed. Having Shawn alive would certainly have outweighed any positive outcome Susan experienced through the pain of his death. Yet, she had a choice to remain in the narratives of suicide and self blame, or envision new narratives that could allow for Shawn’s death to mean more than just loss.

            Susan looked at life very differently following her son’s death, she interacted differently with others. Through this experience, Susan appreciated her relationships more and described Shawn’s death as an experience that changed how relationships worked within her family. Taking this tragic experience to mean more than pain and suffering, self blame, and focusing on how Shawn died, required an opening through which other narratives could emerge. Narratives such as valuing Shawn’s life, their relationship, and the memories of happy times allowed for new perceptions of the event, which allowed for alternative emotions and shaped new memories. In essence, this is about finding hope and meaning through times of tragedy and loss.



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