We do not hold the wisdom that can answer the fundamental questions of living, but we can listen to those who need to grapple with their impacts.
My heart goes out to my Jewish colleagues this week, and their children. It is so hard to make sense of suffering for children, especially at a time when we celebrate family, community and deep personal connection. Every time I see the ugly side of my country, the festering underbelly of racism that seems to flourish no matter what we do and how hard we try to eradicate it, it makes me ashamed of my cultural heritage.
I see the harms of violence every day, against “the other”. Trauma, after trauma, after trauma. As a doctor, with regulatory restrictions on what I can say and do in public, it is even harder to stand for what I believe is right, and true and good, but this week, there is a deep sense of mourning with a community who has suffered so much for so long.
It is easy to feel helpless in the face of such suffering.
The mass shooting at Bondi will have caused significant trauma, and this trauma will ripple throughout the community for many months to come.
For some people, it will be the first time they have seen or experienced this sort of horror, and they might find it difficult to reconcile the beautiful setting with violence, hatred and death. For others, it is a reminder of past trauma in other settings, for other reasons and perhaps for other generations.
Mass trauma events create shockwaves, shaking our fundamental beliefs in ourselves and our communities, and affecting our sense of safety and security.
For GPs, community trauma means being prepared for collateral damage, as people seek our help to manage the fallout. It also means vicarious trauma for us, adding yet another layer to the burden of witness.
We know a lot about managing the distress of community trauma and its individual impact. We know that people often seem to cope for the first day, and then their coping skills may gradually disintegrate over the next few days.
Initially, people need practical support as their normal coping skills may be temporarily overwhelmed. There will be certificates to be written, injuries to be managed and, for some, funerals to be planned and managed. Sometimes, the simplest of decisions can feel overwhelming.
We know that emotional support is essential. We need to listen, and listen to understand, not to solve. We need to validate the suffering, and recognise the impacts: poor sleep, fatigue, irritability, physical discomforts and for some, re-experiencing and nightmares.
For many, this will settle naturally as life begins to reassert its patterns over time. For others, PTSD will emerge, and will need treatment, but in these early days, it is all about stabilising. This means, where possible, returning to “normal” life, or at least a semblance of it. Feeling useful is important, so finding ways to support others may be beneficial.
Unhelpful coping strategies can emerge, like excessive use of alcohol, or misdirected anger towards others or even their own families, and individuals and family members may reach out to their GPs for assistance.
However, perhaps the hardest part of any event like this is trying to make sense of it, especially with children. Parents have the difficult task of explaining what happened, trying to be honest, but also trying to maintain their child’s sense of safety and security.
Related
In these times of existential threat, I find it helpful to use the moral development ideas of Kohlberg. Like most theorists, things are never as simple as the theorists suggest, but the ideas are still helpful. According to Kohlberg, moral development occurs in stages:
- There is good and bad, and people should follow “the rules”. Young children simply need to know that the bad people have been caught and dealt with by the police, and that they and their family are safe. This is the level at which they can reason, and all they need to know.
- People can do good things and bad things, and people who do good should be rewarded while those who do bad things should be punished. The age-old problem of why bad things happen to good people operates here and is a difficult concept for young children to grasp. In primary school, children may place a lot of importance on revenge, so this is a topic that will come up at home. It is important to talk about the law and the responsibility of law to manage justice. Where possible, keep angry discussions moderated with this age group, as it is distressing and destabilising. Of course, they will see you being sad, and this is part of life.
- By mid to late primary school, children will usually be aware of social expectations and will seek authority figures to guide them in responding to difficult social challenges. Community leaders, as well as parents and older family and friends have important roles in teaching how to respond to grieving friends and family, and what the rituals and symbols around death and dying represent. They benefit from discussions about what “good” people can be and do – to quote the great Viktor Frankl (of course): “Forces beyond your control can take away everything you possess except one thing, your freedom to choose how you will respond to the situation.”
- From adolescence, there will probably be deeper engagement in ethical issues, and teenagers and young adults are likely to grapple with difficult questions about values and beliefs. They may have strong opinions and feel betrayed if their community or family do not agree. They may have big emotions that are hard for them to deal with, and hard for their families. GPs working with adolescents can support them as they grieve as grief can be a confusing and alienating experience for adolescents.
Beneath all of that is our own questioning and our own suffering. Some of us will be part of the community that have been harmed, others work within the area where trauma occurred. Sometimes, the work can feel overwhelming.
I’m sure everyone has heard the message that we need to care for ourselves, but it bears repeating.
However, what holds us is the purpose and meaning of what we do. Suffering and death are part of life, and part of our purpose. For many people, we are the profession that sees the “night side of life”, as Susan Sontag would put it, the part we would all prefer to avoid.
We do not hold the wisdom that can answer the fundamental questions of living, but we can listen to those who need to grapple with their impacts. Bad things happen to good people, and it hurts. It isn’t fair, it isn’t just and it doesn’t feel right.
However, I wanted to acknowledge the extraordinary legacy and richness of thought that has come from centuries of suffering within the Jewish community. This is a community with extraordinary strength and wisdom. Jewish doctors, philosophers, writers and Rabbis have grappled with the fundamental question of suffering for centuries. Their rituals around death, dying and suffering are deep and sustaining.
There are extraordinary strengths and resilience within that community, and talking about that legacy with the respect it deserves is important. Connecting with that community will help those who are grieving, because grief like this is woven into the fabric of the community’s history.
For those who are living with deep, senseless loss, all I can offer is witness. Within my consulting room, I create a safe space where people can be tended and wounds can be seen. Around the country, hundreds of my colleagues are doing the same. It isn’t much, but it is a start. And maybe, just maybe, my patients can leave feeling a little safer in this complex world we all inhabit.
If this article caused distress or if you are prompted to reach out for support, these services are available:
Doctors Health NSW hotline: 02 9437 6552
Doctors4doctors crisis support hotline: 1300 374 377
Lifeline: 13 11 14
Beyond Blue: 1300 22 46 36
Associate Professor Louise Stone is a working GP who researches the social foundations of medicine in the ANU Medical School. She tweets @GPswampwarrior.
