Trauma may include many different experiences from abuse and violence to a broken heart and a broken leg. Regardless of the triggering cause, the traumatic experience is individual, although everyone may experience emotional distress like powerlessness, sorrow, frustration, anger, insecurity and anxiety. Here the broken heart and the broken leg are given as examples to bring an understanding of the common reactions of two different traumas.

As a traumatised person, it is natural to feel victimised by the incomprehensible and the unfair. It may be difficult to let go of a trauma even after the fracture or the broken heart is healed. In many ways traumatic events can maintain ourselves in roles as victims and others in the role as offender or helper in addition to the physical experience of loss.

The loss of functionality and the loss of love are sometimes like losing a part of our self.

In this way we may easily forget, that regardless of the visible loss, or the invisible loss, everything is still present. The leg and the boyfriend are still there, they are still a part of us, what we have become through our trauma. We just don’t own the same kind of control over the girlfriend or the leg as we had before. No matter how far we may want to push the trauma, the girlfriend, the disabled leg away, it's all there. Often we experience a similar trauma once again, especially when we have not accepted the previously as part of us, a part of our life experience, a part of the lessons we are here to learn in our life. It is also about letting go of the role of being a victim, and giving others the opportunity to step out of their roles as violator and helper. Anyone who possesses a particular role or assumes the entire responsibility of a specific role is burdened in the long run. In other words the victim, the violator and the helper may suffer equally when stuck in their roles.

So how to live on with our trauma? To me there are the same four levels of healing to be considered: The structural, The functional, The personal and The conscious level. In the immediate acute situation, we often chose to take care of the structural level: the pain of the bone fracture and the pain in the loss of the girlfriend. On the other hand, if this is the only thing, which is taking care of, we may risk getting stuck in an unresolved trauma. There is literally more to be shaken and related to than what can be immediately seen. The shock in the loss of function in terms of reduced strength perhaps even lasting, and the loss of a specific role in a relationship. This is just as much a part of the treatment of a trauma.

Then there is the personal level and the questions we could ask ourselves: Why me? Why again? How do I live so that I get injured? How do I react in a relationship, so that I feel wounded? How is it to be me right now, can I choose to react and act in different ways? Why don’t I ask for the help I truly need? Many questions could be addressed to our personality, our way of being in the world, which might help us understand the trauma, as a part of our life and not our entire life, without being trapped in a role as victim.

Finally, there is the conscious level, the knowledge of all that happened: why the trauma arose right now in our lives. We will probably never find the full answer, as we are not fully awaken human beings on the cellular level and on a higher level of awareness, what I would call a divine perspective.

Nevertheless it helps many traumatised people to seek and find an understanding of what truly happened. It often requires an ability to let go of our common beliefs about the perfect life, the perfect body, the perfect relationship and what is right and wrong. By daring to ask ourselves questions like these: What led this fracture into my life of necessary changes and insights? What does it prevent me from right now, which might in fact be necessary and good for me in my life right now? Who am I behind the bone fracture, and the life I lived before? The same with the broken heart: Who am I without my boyfriend? What did the relationship teach me about myself? Which roles, did I take in the past relationship? Why does it happen right now in my life? What do I need to wake up to since this was not the "end station"? Another reason for understanding the conscious level is that it may gradually relieve the tendency to repeat the trauma over and over again in different variations until we if possible are completely healed.

To me trauma healing is a matter of supporting the person on these four levels, as with many other disorders. I can’t imagine that one doctor or one therapist is able to take care of it all in one treatment, it is a process, however each of us helpers could be aware of these levels in each meeting with a patient/client. This is also a wish for a greater cooperation among doctors, healers, therapists, who may contribute with their talents on different levels, as heeling entirely at the structural level (symptom relief) will never do it in the long run.

A case story from real life may serve as useful examples how a part of this process of trauma healing can be approached:

On my way home sitting in a car I suddenly see some people gathered around a person laying in the middle of a bike path, I stop and walk over to them. A woman is lying on her back completely stiffened with a helmet on her head, there is no blood, and all limbs are intact. Her husband is standing upright keeping their bikes and talks with the people around him. He has called an ambulance and everyone is understandably a little anxious and impatient, as time pass slow in such a situation. Immediately I overlook the situation as quite peaceful, even though I don’t know what has actually happened to the woman and how she fell on her back. Per intuition, I sit down hold her hand, to calm her down. I know that calmness as well as shivering is a part of the treatment of a trauma. I ask her to look at her feet and move them. This small movement diverts her from her anxious thoughts, and at the same time I get useful information: she is able to move her legs, so it is not a serious injury at the structural level. Then she begins shivering, and I support this movement, while I explain to her that it's a natural reaction to the shock her body just has experienced, so I invite her to let it happens as it does. I'm still calm even though the surrounding people are a bit impatient after for the ambulance to arrive. After a while here shivering ceases and I ask her to turn her head gently side by side, which she is doing quite carefully, and by this act something of the stiffness in her neck loosens. The stiffness that occurs in any trauma externally as internally, visible as invisible. The ambulance is on its way, and just before it arrives, she is sitting, and by this act her body remembers that she is intact, even if she is subsequently put down on a stretcher, and treated as an emergency situation with a potentially broken neck and concussion. This is how the system works, and it is necessary in case of severe trauma, but this approach may also create more anxiety and maintain the victim in the trauma, which is not entirely located at the structural level (neck sprain) but also in the personal experience of loss of control and with it a unconscious experience of being close to death.

I imagine this case story is recognisable to many people, since I have met many patients who have been through similar trauma, who are stuck in painful trauma, and who do not understand why the doctor can’t find any “wrongs” at the structural level, or why they don’t feel better after the “wrongs” has been healed.

You may conclude, that it is because I am a doctor it went well in this accident. It's a modified truth. Truly as a doctor I am able to overlook the situation very fast and exclude serious structural damage, but as a doctor I have never learned to take care of the more invisible trauma, how to let go of off the invisible part of a trauma, the emotional shock and the bodily memory in the connecting tissue, muscles and nervous system. Perhaps another casestory could bring some further understanding:

One more case story: Recently a 85-year-old woman was exposed to a serious trauma, where she fell out of a bus and landed on her back bleeding from the back of her head, and with a brief loss of consciousness. Luckily some friendly people around her, including an elderly gentleman, were there and helped her and also the bus driver stayed with her until the ambulance arrived about 45 minutes later. She was taken good care of, and in some way she must have shaken of some of the traumatic event, since she describes, that she had an experience of being paralyzed in one leg and one arm as she woke up on her back. She said I could have died, and she said that she keep on reviewing the trauma: she sees herself falling out of the bus and landing on her back. In the evening she called me, she had chosen to stay at home with herself despite many good offerings of company. She had a little headache, I gave her the advice that painkillers might be very useful, and I said that she could call even in the night, if she needs some kind of help. The next morning she had no more headache, but she realized that she had got a bit pain in her shoulders, still she was completely mobile and planned to take a bus into town to have lunch with a friend. She knows the pain origins from the trauma, and she says spontaneously: “ Now life must continue” something that has been quite difficult for her since the loss of her dear husband a few years back. To me, there was a beautiful symbolism in this traumatic story and the friendly old man who helped her back on her foot in the midst of her experience of lying on her back feeling partially paralyzed in life.

I hope this article may bring a further understanding of the necessity to cooperate in healthcare towards more sustainable health.