Written by Megan Bronson RN, MSN, CS on September 03, 2019
Burn trauma profoundly affects all levels of our being. And recovery needs to occur on each of them. Dealing with and healing from the psychological, emotional, and spiritual impact of burn trauma requires stamina, support, and a willingness to go through the process of grief and to let go when needed. Most of all, true healing or transcendence of burn trauma requires a deep commitment to life on the part of the survivor. The aim of this article is to offer both direction and tools for healing the emotional, psychological, and spiritual impact of burn trauma.
Trauma is defined as an event that is outside the realm of normal human occurrence and threatens the basic safety and security of either the individual who experiences the trauma directly, or those who witness the trauma occurring to others. Serious burns certainly qualify as a major trauma by this definition, both for those who directly experience the burn, as well as family, friends, and significant others who witness the burn incident and its aftermath.
Intrusive, painful medical treatment procedures may also be experienced by the burn survivor and their loved ones as traumatic, even though the intent of these procedures is to facilitate healing of the physical burn injury.
Healing the effects of trauma and loss after burn injury is essential in recovering optimal functioning for the burn survivor, not just physically, but in all areas of their lives, including social, emotional, relational, and spiritual. Healing is possible and available to all survivors if they choose to focus their energy on healing by seeking out individuals, groups, and other supports for healing.
Healing is not the same as curing; it is not about making everything all better nor as it was before the loss or trauma. Healing is about restoring balance given the truth of the effects of the loss or trauma. We live in an impatient culture that likes quick fixes and assurance of outcomes. We function under the pressure of managed care systems and systems of high control, which do not support true healing but rather support expedient treatment. However, that does not have to pull us off track in finding ways to support our own healing or that of others.
The goals of healing trauma are:
To discharge the emotional, physical, and mental energy trapped in the trauma response,
To renegotiate the trauma, (to go back through the trauma on different terms)
To transform the traumatic experience.
In his book, Walking the Tiger: Healing the Effects of Trauma, Peter Levine states that trauma does not have to be a life sentence.
Healing requires patience, trust and a willingness to go through the grief related to the losses that often accompany serious burn injury. Judith Herman MD, a noted expert in helping trauma survivors, describes in her book, Trauma and Recovery, a three phase-model for emotional, spiritual, and social healing:
Phase I — Recovering a sense of safety in the world
Phase II — Remembering, telling one’s story, and mourning
Phase III — Reconnecting with life
In Phase I, the most fundamental psychological impact of trauma needs to be addressed. Namely, the sense of helplessness in the face of an event that is both psychologically and physically overwhelming. This type of event produces a great deal of anxiety in the survivor and challenges a sense of control over one’s life and destiny and ultimately, over death itself.
Reestablishing a sense of physical safety precedes establishment of safety in the survivor’s social environment. For the burn survivor, control of pain, both from the burn itself, as well as intrusive procedures, is essential in helping the burn survivor reclaim a sense of personal power and control.
Survivors feel not only a loss of control over their bodies, but over their emotions and thinking as well. Survivors of trauma also often struggle with a sense of spiritual crisis or crisis of faith. They may feel spiritually betrayed and/or unprotected. Healing the connection to one’s inner self or spiritual center is an essential part of recovery.
True healing also requires remembering, telling one’s story, and grieving the losses related to the burn trauma. In Phase II, the survivor needs to be allowed to process the loss and trauma in order to put that in the past. Common losses related to burn trauma are as follows:
Possessions, such as home, mementos, etc.
Relationships that may have ended relevant to the burn trauma and injury
Loved ones who may have died in the fire
Pets who may have died in the fire
Dreams and hopes
Body parts, function, hair, ears, sight, etc.
Roles, lifestyle, recreational, and employment changes
Past life—what one used to look like, be like, enjoy doing, etc.
The grieving process is an innate, natural part of the healing process. The feelings of grief include sadness and despair, anxiety and fear, anger, yearning for what was lost, and guilt. These feelings may occur in any order and may last a long time. Going through these feelings, rather than blocking them, helps us to heal. The goal of grief is to help us to integrate the changes brought about by the traumatic event, find meaning in the loss, and find a way to go on with life.
Although improving, our culture is not traditionally supportive of this natural process. Not everyone is able to be present to the grief of another. Therefore, becoming a part of a support group, such as a burn survivor support group, or seeking supportive counseling (from a professional trained in dealing with grief and trauma issues) can be helpful in moving through grief. Journaling, drawing, and spiritual practices, such as prayer or meditation, are also helpful in supporting grief.
Irving Yalom, MD, who has extensive background in working with groups and teaching group theory states, “The encounter with others who have undergone similar trials dissolves feelings of isolation, shame, and stigma.” The burn survivor needs to be allowed to tell their stories in an emotionally safe, nonjudgmental environment. Peer support relationships, burn survivor support groups, burn camps and retreats, and conferences specific to the trauma, such as the Phoenix World Burn Congress, provide such a place. Anyone who has witnessed the healing power of the open microphone sessions at Phoenix World Burn Congress where burn survivors share their stories will attest to that.
As reconnecting in supportive relationships and groups becomes easier, it also becomes easier to reconnect to the world of family, friends, jobs, and other social relationships. In Phase III, the emphasis shifts from being a burn survivor to being oneself in the world again. As healing occurs on deeper levels, the fact that one is a survivor of burns does not constitute the only part of one’s identity.
While traumatic incidents are not our choosing, recovery, healing, and finding a way to move forward in life and to transcend trauma are. These are possible when we choose to heal, recover, and set our intention on these. The concept of post-traumatic growth (PTG), once rarely considered as a possibility, is entering the consciousness of more and more survivors, as well as caregivers, counselors, and burn care professionals. PTG refers to the possibility of recovery, positive change, and spiritual growth after traumatic injury and traumatic loss.
Human beings have the potential to make positive, life-affirming choices and changes in response to trauma. Many survivors decide to do something positive with their lives in spite of their trauma and also, for some survivors, because of it. Many choose to take what they have learned from their struggles and suffering on the road to recovery to make a difference for others who are still struggling. The SOAR program of the Phoenix Society for Burn Survivors is a wonderful example of this.
Those who are part of the burn survivor’s support system also can experience PTG in the process of healing and recovering after burn injury. We can become less judgmental and more compassionate, caring, and loving human beings.
Research indicates that the most important factors in the recovery and healing process after traumatic injury and traumatic loss are
A strong social support system
Cognitive and emotional processing to the trauma
An openness to spiritual growth and change
Never underestimate the power of focused will and intent and the power of the human being to not only survive profound and unimaginable trauma and traumatic loss, but to go on to thrive and even transcend these experiences. Those of us who have the privilege of working with burn survivors can share many examples of this.
Many years ago I worked with a young man who was struggling with a serious physical illness. He was also a long distance runner. He was a profound teacher for me about the power of will and intent. He told me that as he trains for a marathon, he always visualizes himself finishing the race. He shared that it is what got him through the tough times and kept him going when he wanted to quit—when he thought he could not endure. He applied the same principle to dealing with his physical illness—he never quit.
It was that clear focus of intent that helped him as a runner and also as a human being dealing with adversity. I never forgot the lesson. Focus your intent, will, and goals carefully and deliberately on healing and recovery.
To survive refers to overcoming a threat and to endurance. To thrive refers to resuming growth and to developing potentials. One has to go through the process of becoming a survivor and then learning to thrive again before one can transcend trauma. To transcend trauma and loss refers to a level of healing in which the individual is able to take what they have learned from going through the trauma and use it to make a difference in the world.
To transcend means to go beyond or to surpass limitations and to transform suffering into healing for oneself and/or others. That might mean helping other survivors directly, or it might mean making the world a little better place in general by making a difference for others.
The journey of healing and recovery after a burn injury is not a sprint, buta marathon. It takes courage, endurance, and support to recover and find balance after traumatic injury. Like the marathon runner, set your intention on recovery, growth, healing, and reclaiming your life.
Burn support groups, grief and trauma groups, 12 Step Program
Burn camps, family retreats, and age appropriate retreats for adolescents, young adults and adults
Support from family, friends, church, or community groups
Tai chi, ki gong, yoga, therapeutic massage, reiki, sensory motor work
Therapies that facilitate cognitive and emotional processing of the trauma, such as cognitive behavioral therapy, or CBT (http://www.nacbt.org) and eye movement desensitization and reprocessing, or EMDR (http://www.emdria.org)
Online supportive resources—The Phoenix Society for Burn Survivors (http://www.phoenix-society.org)
The Phoenix World Burn Congress and Phoenix UBelong children’s program developed by the Phoenix Society http://www.phoenix-society.org/wbc
Phoenix SOAR (Survivors Offering Assistance in Recovery) Program http://www.phoenix-society.org/soar