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The impact of war trauma, the challenge of objectivity, and the power of therapy and storytelling in healing

Arthur Lazarus, MD, MBA
Physician
April 25, 2024
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Trauma in the form of war is one of the worst forms of trauma to endure. How do people remain objective about events and the involved nations when they have been directly or indirectly affected by war?

For example, how are Holocaust survivors and their families able to unemotionally relate to present-day German citizens? How do the descendants of the more than 2,000 allied civilians who were imprisoned in the infamous Japanese-controlled Weihsien (China) Internment Camp look upon today’s Japanese nationals dispassionately? How can one criticize Israel’s rampage on Gaza without being labeled antisemitic or feeling the need to run amok on college campuses and threaten Jewish students?

War trauma, with its profound psychological distress, can significantly impact an individual’s perception of events and countries involved in the conflict. This trauma can be experienced directly through personal exposure to war or indirectly through the suffering of loved ones. The after-effects often persist long after the conflict has ended, leading to a range of mental health issues, including post-traumatic stress disorder (PTSD) and depression.

Maintaining objectivity in the wake of such trauma is undoubtedly challenging. However, several strategies can assist individuals in this process. Psychoeducation plays a crucial role in helping individuals understand the nature of trauma and its impact on mental health. This understanding can lay the groundwork for a more objective analysis of events and nations.

Professional therapeutic interventions such as cognitive (or dialectical) behavioral therapy (C/DBT) and eye movement desensitization and reprocessing (EMDR) can be instrumental in dealing with trauma. These techniques can help individuals restructure their thoughts and emotions, allowing them to view events from a more objective standpoint.

Practices like mindfulness and meditation can also be beneficial. By helping individuals stay grounded in the present moment, these practices can minimize the influence of past trauma on current perceptions.

A strong support system encompassing friends, family, or support groups can provide varying perspectives and a safe space for discussion. This facilitation can encourage the development of a more objective viewpoint.

Gaining education and exposure to different cultures, histories, and perspectives can foster understanding and empathy. However, these appear to be critically absent from the war between Israel and Hamas, fueling tensions and preventing individuals from forming a more balanced view of the conflict.

In addition to the therapeutic interventions and strategies already mentioned, medication may play a crucial role in managing the symptoms of trauma and promoting objectivity. Pharmacotherapy can be beneficial in managing the symptoms of both PTSD and depression, as well as various anxiety disorders that may accompany trauma.

For instance, selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) are often used to treat these conditions. These medications can help regulate mood, reduce anxiety, and improve overall well-being, thus providing a more stable emotional platform from which to view events objectively.

Antipsychotic medications may also be used in some cases, particularly when individuals are experiencing severe symptoms such as hallucinations or delusions. Antipsychotics are also used to augment the potential of antidepressants, especially in individuals whose depression proves difficult to treat. Modern, “second-generation” antipsychotic drugs can help stabilize the individual’s mental state and improve their ability to perceive reality accurately.

It is important to note, however, that the use of medication should always be considered as part of a comprehensive treatment plan that includes the psychotherapeutic modalities discussed above. Furthermore, the decision to use medication should be made collaboratively between the physician and the patient, taking into account the individual’s specific symptoms, overall health status, and personal preferences. It is also vital to remember that healing from trauma is a gradual and individual process. Each person’s circumstances should be approached with patience, empathy, and respect for the individual’s personal journey.

Because recovery from trauma is unique to the individual, storytelling has emerged as an effective therapeutic tool in helping individuals process and cope with the psychological distress caused by war trauma and other types of trauma. It provides a safe and structured platform for expressing emotions related to traumatic experiences. This form of expression can offer relief and reduce symptoms of distress. The story shepherds of war-torn Northern Ireland can attest to the healing power of storytelling.

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Storytelling has also been instrumental for many Holocaust survivors. The act of sharing their experiences—”Shoah testimony”—has served multiple purposes, both for the survivors themselves and for society at large. Storytelling has been a way for survivors to reclaim their identities, sustain their resilience and strength, and come to terms with the unimaginable events they lived through.

Narration provides a sense of control and self-affirmation. By narrating their experiences, Holocaust survivors have been able to contextualize their suffering and find some form of closure. Moreover, the stories serve as a powerful warning against the dangers of hatred, prejudice, and indifference. They remind us of our responsibility to uphold human rights and prevent such atrocities from happening again.

Storytelling encourages cognitive processing. As individuals recount their experiences, they can gain a better understanding of their trauma, helping them to reframe their experiences, challenge negative beliefs, and develop a more balanced perspective. Storytelling also fosters a sense of connection and empathy among those who have experienced similar traumas. This shared experience can reduce feelings of isolation and provide a supportive community. In addition, the act of telling one’s story can be empowering. It helps preserve personal and collective memories of traumatic events, whereas repressing them may hinder the healing process.

The integration of storytelling into therapeutic interventions can take various forms, such as narrative therapy, writing exercises, or group therapy sessions. Digital media like video or audio recordings can also facilitate storytelling, providing a platform for wider sharing and advocacy. Although storytelling is a powerful tool in managing war trauma, it should be facilitated with sensitivity, respecting each individual’s readiness to share and their unique narrative.

Arthur Lazarus is a former Doximity Fellow, a member of the editorial board of the American Association for Physician Leadership, and an adjunct professor of psychiatry at the Lewis Katz School of Medicine at Temple University in Philadelphia, PA. He is the author of several books on narrative medicine, including Medicine on Fire: A Narrative Travelogue and Narrative Medicine: Harnessing the Power of Storytelling through Essays.

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