When the Trauma Ends
As the traumatic event ends, the phase known as the acute post-traumatic period begins. During this time, the mind and body slowly move back down the arousal or dissociative continuum. The child moves from the brink of terror through fear, alarm, and, with time and support, back to calm (see Figure 2-2 above). Heart rate, blood pressure, and other physiological adaptations normalize.
If a child can move back down the arousal continuum, his or her brain will resume baseline (pre-trauma) styles of thinking, feeling, and behaving. Hypervigilance decreases and the mental mechanisms related to attention begin to normalize as well. The child that has dissociated will begin to pay attention once again to external stimuli.
Conversely, the child that has been completely focused on external cues related to threat will actually pay attention once again to internal stimuli (e.g., feelings, thoughts, sensing their pounding heart, or noticing the cut on their leg from diving under a desk during a shooting).
Making Sense of the Event
During this acute post-traumatic period, the child will now perceive the sense of fear and anxiety. This is when they will actually feel the fear associated with the trauma. The individual will begin to process and think about what has happened, attempting to make sense out of the events just experienced. Because the traumatic event is so far out of the normal range of experience, there will be a variety of mental attempts to process and "master" this event.
The traumatic event will play itself out in the mind of the child again and again. A host of intrusive images related to the trauma may swamp the child's thinking. This set of re-living and re-experiencing phenomena may include telling the story over and over again to friends. The child may act this event out in play and drawings (see below) or experience intrusions (flashbacks or nightmares). In essence, these children have created memories of the traumatic memory.
Living With Created Memories
The death of a loved one, for example, is a trauma that can influence memory. Over the six months following the loss, children (as well as adults) will often experience unusual visual, auditory, or tactile sensations. A child may think they hear the deceased person's voice, or they think they saw them in a crowd, or out of the corner of their eye they may see their reflection in a window. At bedtime or when awakening, these misperceptions are more common.
Such "memories" may be disturbing to parents, caregivers, and the child. The child needs to be reassured when these memories of the loved one occur. These "visions" are often interpreted in context of a religious belief system ("They came back to tell me it was OK"
or "They are still with me"). This can be important for the child and there is no reason to undermine these feelings. These "hysterical materializations" are common and often mislabeled as visual or auditory hallucinations.
These types of memories are complex. Traumatic memory involves the storage and recall of information at several levels. The brain stores not only traditional cognitive information, such as who, what, when, and where, but also emotional information: feelings such as fear, dread, and sadness.
The old adage that "the body remembers" is referring to motor-vestibular information. An example of this might consist of a memory of the body's position during the rape. Finally, the brain contains a state memory, such as vigilance or physiological hyperarousal.
A Difficult Process
The normal and predictable mental mechanisms that are used to process all experiences will, at times, fail in the attempts to master and understand a traumatic event. Because traumatic events have features that are so outside the range of normal experience, there are very few internal experiences with which to judge or make sense out of the event.
The more outside the range of the normal experience and the more life-threatening the experience, the more difficult it will be for the normal mental mechanisms to work efficiently to process and master that experience. The inability to control elements of the traumatic event, or the intrusive thoughts that follow, lead to a set of predictable mental and physiological responses.