Page 231 - Creating Spiritual and Psychological Resilience

200 Creating Spiritual and Psychological Resilence

nature held by them so that they would be able to understand their vary-
ing professionals’ recommendations and choices of action. As an example
from a related field, one cannot but follow Esposito’s (2006) recommenda-
tion to nurses who “unknowingly encounter survivors of sexual assault
every day in clinics, ambulatory care centers, emergency departments,
and inpatient units. These patients may have a variety of acute and chronic
physical or emotional conditions, which include migraine headaches, gas-
trointestinal disturbances, depression, or substance abuse. While these
presenting problems are addressed, the underlying cause may be missed.”
Emphasizing that “healthcare visits can be reminders of a sexual assault,”
she suggests that “nurses can ask questions, listen to patients, and be sensi-
tive to potential indicators of abuse, which all can assist patients who have
a history of sexual assault toward an emotional healing process” (p. 69; see
also Mezey, Bacchus, Bewley, & White, 2005) on health professionals in
the context of maternity care and Cloitre, Cohen, Edelman, & Han, 2001,
as related to medical problems and care).

Trauma Exposure and “Fixity”

Trauma exposure can cause a rupture, a possible regression, and a state
of being “stuck” or “frozen,” which I have termed fixity. The free flowing
state of smoothly negotiated, multiple identity dimensions associated with
healthy adaptation to a complex and changing world becomes rigidified
and less functional. The intent, place, time, frequency, duration, intensity,
extent, and meaning of the trauma for the individual, and the survival
strategies used to adapt to it, will determine the degree of rupture and
the severity of the fixity. Although there is a dizzying array of complexly
interacting factors determining the severity and the heterogeneous ways
individuals are affected, it is beyond the scope of this chapter to describe
a predictive model. However, when working with affected individuals, it
is necessary to explore the above-mentioned factors, as appropriate for the
setting and, with appropriate supervision, to clarify and evaluate these
factors as they pertain to the individuals with whom you work.
Fixity can be intensified, in particular, by the conspiracy of silence
(Danieli, 1982, 1998), the survivors’ reaction to the societal—including
healthcare and other professionals—indifference, avoidance, repression,
and denial of the survivors’ trauma experiences (Symonds, 1980). The
effect of this strong taboo against speaking cannot be overemphasized.
Society’s initial emotional outburst, coupled with a socially constructed