Rhianna explores how trauma can affect communication skills.
“The physical trauma – or more precisely the memory of the trauma – acts like a foreign body which long after its entry must continue to be regarded as an agent that is still at work”. – Freud and Breuer
Trauma is a subjective experience which overwhelms a person’s ability to cope. It may involve an individual feeling as though there is a direct threat to their life, sanity, or safety. In an effort to survive, preserve a coherent sense of self, and process the traumatic experience, the brain seeks out various coping mechanisms.
The brain can make mistakes – and these coping mechanisms may leave enduring consequences on an individual’s ability to integrate their emotional experiences and process information. The shadow left by a traumatic event may affect how an individual presents, behaves, communicates, and relates to others.
Research into the understanding of trauma is developing. Increasingly, professionals and practitioners across many fields are shifting towards a trauma-based perspective when dealing with those who live with Post Traumatic Stress Disorder (PTSD). However, this has not always been the case. PTSD has only existed as a diagnosis since 1980. Prior to this, veterans and victims of abuse who were suffering, with what we now call PTSD, would be routinely misdiagnosed with a plethora of conditions, including alcoholism, substance abuse, depression, mood disorder, schizophrenia, or neuroses.
Whilst people diagnosed with PTSD may experience any of the aforementioned conditions (plus many, many more), trauma lies at the heart of the issue. The roots of trauma run deeply, the consequences and effects branch wide.
Fight, Flight, Freeze, Collapse
Our nervous system is ancient. Like all species, humans have evolved self-protective mechanisms to help us survive imminent danger. This system evolved to mobilise us away from very real threats such as, a predator, a landslide, or a fire. The complexity of modernity means, however, that the dangers we face are not always as concrete as they were historically. We may misinterpret safe situations, seeing danger where none exists. Before our rational brain can process and de-escalate the situation, our central nervous system has already sprinted into action.
Trauma survivors are often hypervigilant to danger. They may be far more likely to misinterpret situations, to feel like danger is imminent and inescapable, when in fact they are perfectly safe. Individuals with PTSD are effectively on hyperalert. Their fight or flight response has been hijacked, meaning that this chain reaction can be quickly triggered.
Once this chain reaction has been set off, the body is running on pure instinct. This is an extremely physical response. The amygdala (the stress centre of the brain) fires stress hormones called cortisol and adrenaline through the body. The pupils dilate, and we experience the phenomenon of tunnel vision. Blood flows to the major muscle groups such as the thighs, and arms, preparing us to run from or fight off an attack. The breath and pulse quicken, our blood pressure increases, and we are elevated to a heightened state of tension. The intensity of this physical response can have serious consequences for our ability to communicate, and we may struggle to articulate our feelings, to decipher meaning and to express ourselves coherently.
Courtroom environments can be extremely overwhelming, in particular for people with PTSD. The atmosphere is heightened and stressful, the pressure on the individual is intense, and the consequences are often life changing. Breaks from the court environment can interrupt the mounting anxiety trauma survivors may be feeling. Intermediaries can monitor the emotional presentation of service users and alert the court if it deteriorates. Taking some time and space away from the court environment can reset an individual’s anxiety levels and allow them to de-escalate their panic response.
The intermediary can assist further with this by implementing grounding exercises. These exercises may include guided deep breathing with a particular focus on the outbreath, as this stimulates an individual’s parasympathetic nervous system and slows their heart rate. The intermediary may also guide the service user through exercises to assist them to reconnect with their senses, for example, by asking them to name 5 things they can see, 4 things they can hear, 3 things they can feel, 2 things they can smell and 1 thing they can taste.
Feeling a sense of presence and connection with the earth can bring us back to the current moment, and the intermediary could invite the service user to feel the full weight of their body against the floor or chair. The path of the vagus nerve carries messages of panic through the throat, chest, and abdomen. Grounding exercises can help to direct an individual’s focus away from this system. Focusing attention on the hands, which lie outside of the path of the vagus nerve, can create physical sensations which can counterbalance the feeling of being out of control. The intermediary could introduce the use of fidget objects or offer the service user some paper so that they can draw, write, or shred. The intermediary may guide the service user through some gentle movement, such as tapping on the pressure points, or simple stretches. These exercises can help create space and movement in the mind, body and voice, which acts as an antidote to the frozen, paralysing fear we experience when living in a traumatic moment.
Speaking out and sitting down
As part of our instinctive panic response, a key area of our brain which is used for communication – known as the Broca’s area – completely shuts down. The Broca’s area is a key speech centre, and if this part of the brain stops functioning, you are effectively unable to articulate your feelings. This poses enormous challenges to individuals who are required to give evidence in court.
With an impaired Broca’s area, individuals in court will struggle to alert professionals when miscommunications occur. They may have difficulty recognising and advocating for breaks when they are needed. They may struggle to decipher meaning when presented with information which uses low frequency vocabulary (for example, the word, ‘instigated’ may be harder to process and understand than the word, ‘started’). They may also struggle to comprehend complex sentence structures, such as tag questions, or questions which contain multiple parts. Of course, all of these issues are only magnified if the individual already experiences barriers to their communication in their daily life. Any pre-existing communication difficulties will be exacerbated, at a time when effective communication could not be of greater importance.
When asked to give evidence in court, individuals who have PTSD may become so overwhelmed that they can barely speak. Their nervous system may be hijacked into a state of panic, rendering them unable to clearly articulate what happened to them. Their evidence may be fragmented, chaotic, confusing, or incoherent. Alternatively, they may try and recount the events of what happened to them in a way that prevents them from becoming triggered. This may result in their responses appearing evasive, minimal, or unreliable.
An integral part of the intermediary role is assessing the communicative ability of the individual service user and intervening to ensure that the questions asked of them in evidence are appropriate for their communication profile. At the assessment stage, the specific difficulties each service user faces will have been identified, and recommendations for effective communication will be set out in the intermediary report. However, the service user’s ability to process and understand language may fluctuate, and this will need to be constantly monitored by the intermediary. If a service user enters fight or flight mode, they may become far less able to process question types which ordinarily may not pose any issues.
The intermediary can alert the court’s attention to complex question types and offer suggestions for simplifications. Ensuring that language is kept extremely simple and that questions are short and easy to understand, will assist the service user to provide their best possible evidence to the court. If the evidence given by the service user lacks sufficient detail, the intermediary can also recommend the use of simple, follow up questions, such as, “Where did you go next?”, or, “What happened after that?”. If the service user is unable to understand or process verbally presented information, the intermediary can intervene and offer visual explanations, using simple visual aids. These strategies are not only effective when a service user is giving evidence, as the intermediary can continue to use visual aids and give verbal simplifications throughout proceedings to support comprehension.
Our nervous system is a powerful thing, and the intensity and regularity of the fight or flight response can have lasting consequences for how trauma survivors understand, process, and retain information. Over a prolonged period of time, constantly elevated stress hormones can have serious impacts on the memory of traumatised individuals and their ability to maintain concentration and attention.
The court environment was not designed with PTSD survivors in mind. In court, there is often large volumes of complex verbally presented information, which contains unfamiliar or court-specific language, such as ‘indictment’, or ‘threshold’. This can be extremely fatiguing for individuals with trauma-related communication difficulties to process. In addition to this, the court environment has an intensity which requires focused attention, and due to time pressures, breaks are not always factored in.
This is where intermediaries can assist individuals with PTSD to access and participate fairly in the justice system. Having a timetable or checklist of what is coming up within the court day can manage expectations and assist the service user to maintain their attention. Another key strategy which intermediaries may implement to support the retention and concentration of individuals with PTSD is enabling regular breaks. The intermediary can closely monitor the presentation of the service user, and if it is clear that the fight or flight response has overwhelmed their ability to participate fairly, then the intermediary can advocate for breaks and alert the court when they will be necessary. In these breaks, salient points from proceedings can be repeated and recapped to assist retention. Time should also be carved out within the break for the service user to have a complete rest from processing, which will then enable them to concentrate more effectively when they return.
Flashbacks
A common experience of trauma survivors is that of visceral flashbacks. These flashbacks are intense physiological experiences and do not operate in the same way that typical memory does. When an individual with PTSD is presented with images, sounds or thoughts which relate to a traumatic event, the amygdala lights up in alarm. Physiologically, their body reacts as though the traumatic event is ongoing, as though the danger is immediate and inescapable, even if their brain is simultaneously aware that there is no tangible risk of harm.
When a flashback occurs, the left hemisphere of the brain deactivates. This can have disastrous consequences for an individual’s ability to communicate coherently. Without the left side of the brain functioning, the individual may find themselves unable to name and compare things and understand how one thing relates to another. They may be unable to organize and sequence events, and whist being consumed with overwhelming emotions, individuals may have extreme word-finding difficulties. This can leave them feeling incapable of communicating their subjective experiences to others.
The court environment is rife with stimuli that could trigger a flashback or adverse reaction. When attending court, individuals may be required to publicly relive traumatic events. Some may be faced with seeing the perpetrator of their trauma. Individuals may undergo cross examination which may feel invasive, personal, or triggering. The subjects that are discussed in proceedings are often highly sensitive, and even if not directly related to their trauma, could nonetheless stir up distressing memories and feelings. In addition to this, the unique formality of the court environment, the stakes and pressure of the situation, as well as the anticipation and anxiety surrounding court attendance, could all act as further catalysts.
As intermediaries, we can implement various strategies to minimise the risk of an individual experiencing a flashback. If the service user is likely to be triggered by seeing a particular individual in a court setting, intermediaries can recommend the use of special measures, such as screens, to shield the service user from being visually confronted with the source of their trauma. If the court building itself could be a trigger, we could implement a familiarisation visit, to allow the service user to acclimatise to the environment in which the proceedings will be taking place. If this does not alleviate the service user’s anxiety, we could recommend that the service user attend remotely from another room in the court, or even a neutral building, such as a solicitor’s office.
Whilst attending court remotely certainly has its own complications, for some service users it can be a far less anxiety inducing experience and enable them to fully participate in their proceedings. Some individuals may find authority figures intimidating and could feel triggered by the hierarchical structure of the court environment. In some cases, a service user’s anxiety can be alleviated if certain court specific formalities and traditions are forgone. For example, it may be helpful to refer to traumatised individuals by their first name, or to allow them the opportunity to meet the advocates and judge prior to the court hearing. Some traumatised individuals may have a comforting object, or a person who provides emotional support who they may wish to accompany them to court. The presence of a reassuring object or individual in such an overwhelming environment may help to create a feeling of familiarity and safety.
Rapport and repair
Trauma is a rupture which can drastically alter how we view ourselves and interact with others. Those who have been traumatised may have great difficulty trusting new people. If their trauma was enabled by an abuse of power, they may find it particularly hard to engage with professionals and authority figures. It is for that reason that building a rapport is so fundamental to the intermediary role when working with trauma survivors. This rapport is the foundation on which all other assistance provided by intermediaries is layered. If the service user feels comfortable and relaxed working with the intermediary, they are more likely to express their lack of understanding or their need for a break. They may engage better with simplifications and explanations provided in court. In addition to this, there may be an increased likelihood of the intermediary being able to effectively assist with managing any emotional dysregulation.
Humans are innately social beings. When we feel under threat, we instinctually turn towards others to seek reassurance or call for help. If our distress is recognised and reassurance is given, this can go a long way to avoiding the stress response escalating to a fight, flight, freeze or collapse response. It may sound simple but acknowledging an individual’s emotions can be an extremely useful tool for de-escalation. Simple mirroring statements, such as, “I see you are very upset”, “I know what Mr X said made you very angry”, or “I understand that you feel very anxious about tomorrow”, carry a reassuring message: that the service user’s subjective experience is heard, understood, seen, and acknowledged. Having an intermediary in court can provide a soothing and steadying presence for those who suffer from PTSD. Whilst an intermediary is impartial, our purpose at court is specifically to assist the service user. For the service user, knowing that there is someone there who will be attentive to their communicative needs, and provide support when necessary, can be hugely beneficial in managing emotional dysregulation over the course of proceedings.
Trauma is complex and subjective. The ripples that it creates are far reaching and unique from individual to individual. With appropriate therapeutic intervention, traumatic experiences can be re-integrated and processed by the ever learning and adaptable brain. Left unresolved, however, trauma can permeate all aspects of how one interacts with the world. Individuals with PTSD who are required to attend court can feel as though they are being left exposed, vulnerable and at risk of re-traumatisation, if their experience is not adapted to meet their unique needs. Intermediary support can enable individuals who carry the complex scars of a traumatic past to participate fairly in a justice system which may often shine a light directly onto their wounds.
