These seniors face the same mental and physical health care needs as people on the outside, experts say, but they’re growing old in a system already strained by the sheer numbers of prisoners, to say nothing of the pressure created by the COVID-19 pandemic. Their plight is the focus of Aging Behind Prison Walls: Studies in Trauma and Resilience (Columbia University Press, 2020), a new book co-authored by Professor of Social Work Tina Maschi, Ph.D., and Keith Morgen, Ph.D., associate professor of psychology at Centenary University.

From Isolation to Solitude

Maschi noted that although the book focuses on aging in prison, it is also a story of humanity. Its data-driven analysis—both quantitative and qualitative—reveals that the men and women behind bars have mustered a resilience that could teach those of us on the outside a thing or two, said Maschi, particularly when most Americans are coping with pandemic isolation.

“Now we’re all in a metaphorical prison, so why don’t we ask the wisdom keepers in prison, what does it mean to take social isolation and view it as solitude?” asked Maschi.

Maschi said the coping strategies used by incarcerated elders include finding meaning in their lives from before, during, and after imprisonment. But society undervalues incarcerated people, so their wealth of knowledge falls mostly on deaf ears. Over the years, Maschi said, she’s come to appreciate older incarcerated people for their unique and informed perspectives.

“One of the elders once said to me, ‘You may have a Ph.D., but I have a direct line to the wisdom only others can read about in your research,’ and I realized he was right,” said Maschi.

Trauma Begets Trauma

Over the course of 10 years, Maschi interviewed 677 incarcerated people for the Hartford Prison Study under the jurisdiction of the New Jersey Department of Corrections. The research produced multiple journal articles, including a study of some frequently overlooked communities, such as LGBT incarcerated elders. But perhaps her most significant finding was that 70% of the participants experienced three or more traumatic experiences in their lives, including physical and sexual abuse. The ill effects from these experiences linger for many years later, she said. And yet, her research also found that older incarcerated adults who had spent years working through the trauma lived healthier lives into their senior years. They, in turn, passed on the knowledge to younger men and women in prison, of which many were able to make positive changes in their lives.

One young man she calls Joseph credits a prison elder with helping him turn his life around. Joseph had been abused by his parents and a coach. With the help of an elder he was able to gain insight into “what happened to me and what I had to do to get ahold of the monster in control of me,” he tells her in the book. Before that he experienced “a world locked away from all caring feelings and [he]put on a tough exterior.”

Based on the data, Maschi said, “If we give them love instead of suppressing love we know that people have better results.”

Prison as a Metaphor

Maschi worked in prisons for 15 years before finding her way to the older adults there. Initially, she researched young prisoners and wanted to understand trauma in their past that paved the way to incarceration. But she also wanted to examine outcomes of being incarcerated over several years, which led her to the older population. In time, she said, she has come to view America’s mass incarceration crisis as analogous to society’s greatest ills.

“The prisons are a metaphor, these are stories of humanity and we need to understand how we got to this point because if don’t want to look at how we got here, we’ll never get out of it,” she said. “And if we don’t do something, we’ll be looking at thousands of people dying, including many chained to beds, and that problem is only going to get bigger and bigger.”

Maschi said that most Americans’ personal and collective beliefs don’t align with the brutality of mass incarceration. She said much of the problem springs from a “fear-based mentality” fostered by the media that distracts people from focusing on the positives that incarcerated people may have to offer.

Caring Justice

Maschi and Morgen offer concrete proposals—at the community and national policy levels—to address the pressing issues of incarcerated elders. The authors document multiple examples of compassionate programs and interventions that incorporate what they refer to as “caring justice” principles. The approach provides a formalized framework for professionals that integrates “caring” by emphasizing equality, compassion, and authenticity, and “justice” by emphasizing truth, integrity, balance, and ethics. can help everyone examine “how we value, treat, and care for each other.” But the principles are specifically intended to help marginalized individuals and groups, like those with a criminal past, heal and grow. In essence, their recommendations spring from the care that incarcerated elders are already providing in an informal way to younger imprisoned adults

“Caring justice is not coming, it is already here. If you open your eyes you will see it.  While the rational view is respected, it should be tempered by the heart and expressed through compassion,” she said.  “There’s science behind this; we know from our other research that oppression and hatred often are associated with health and justice disparities. In comparison, a compassionate and authentic approach is most often associated with better health, well-being, and an increased sense of belonging.”

Caring justice is a “heart and head integration” method that Maschi says is best expressed in the spiritual creative writing of an incarcerated older adult known as Mr. J’s Unchained Mind, who is briefly mentioned in the book. Maschi writes that Mr. J’s Unchained Mind enables him to be fully aware of his inner landscape and his relationship to the world.  In one paragraph introducing a poem by Mr. J, the authors reference 15 empirical studies that support the importance of “biopsychosocial spiritual medicine” to promote resilience, transcendence, and well-being. That is to say, Mr. J’s faith. He writes:

I was once a Fool but now I’m Wise!
I was once Blind but now I See!
I was once Deaf but now I Hear!
I was once Ignorant but now I use Intelligence!
YOU have your Ph.D., but I have Knowledge and Inspiration that comes from a Higher Power, the one and only True GOD!
A Mind is a terrible thing to waste, so is the Soul!

Looking beyond the headlines, Gregory Acevedo, Ph.D., an associate professor at Fordham’s Graduate School of Social Service, says there is real human misery associated with immigration that we have a moral responsibility to address.

Listen here:

And in an extra track, Acevedo talks about the mental health needs of Puerto Ricans affected by Hurricane Maria who are expected to move to areas such as Florida and New York City this year.

Full transcript below:

Gregory Acevedo: U.S. social policy history’s really continuing history of reform and reaction. It really is this kind of like few steps forward, a few steps backwards. Maybe in the long rhythm of time, you’re moving forward. We have these regressive periods where we really do turn the clock back, unfortunately return to some past ways of thinking and doing. They’re never fully gone. There’s always some tinge of nativism that’s out there.

Patrick Verel: Few issues burn hotter on the worldwide stage today than immigration. In May, President Trump instituted a zero tolerance policy for anyone arriving at the southern border. Today, many immigrant children, who were taken from their parents there, have yet to be reunited. It’s rattling Europe as well. Italians recently elected a coalition government formed by two antiestablishment parties who share a common dislike of immigrants.

But beyond the headlines, Gregory Acevedo, an associate professor at Fordham’s Graduate School of Social Service says there is real human misery that we have a moral responsibility to address. I’m Patrick Verel and this is Fordham News.

What is the Immigrant Behavioral Health Roundtable project, and why is it so important these days?

Gregory Acevedo: The project’s being organized by the New York Immigration Coalition. They invited me because of the work that I’ve done in terms of immigrant and refugees and their mental health and social service needs. They’ve become concerned that with the Trump administration’s current policies that it’s having a negative impact on the behavioral and mental health of immigrant communities in New York City and elsewhere, of course. It involves people from government, healthcare providers, researchers, advocacy, and community based organizations, and the actual community members themselves.

The goal really is to develop long term policy recommendations for how to increase access to behavioral health for immigrants. In response to the current crisis, but also with the long term view that after this crisis is gone, trying to improve really behavorial healthcare access for immigrants period. It’s important because behavioral health is such a critical component of wellbeing for any person, non-immigrant or migrant alike. For example, behavorial health affects our physical health, our relationships, our job performance.

Migration inherently involves stress. Even a legal migrant coming with all their papers, well-resourced, there’s going to be some degree of stress. For any migrant, the context of the reception that they receive is a powerful determinant of how they’re able to cope with that stress. I think unwelcoming contexts heighten the risk of behavorial health problems occurring. We’re certainly in current context that’s pretty unwelcoming.

Patrick Verel: A key aspect of the debate happening in the country is the distinction between immigrants who come here legally and those who come here illegally. From a mental health perspective, do you see any distinction between these two?

Gregory Acevedo: Yes, insofar as illegality involves a higher level of, let’s say, risk and uncertainty. The fact that it heightens anxiety and insecurity. The fact that kind of living on the run, as it were, involves additional stressors than those that are already part of the stress involved in migration. I think there’s definitely a difference between an illegal journey and a legal journey.

I think it, for a healthcare provider or a mental healthcare provider, the issue is to be attuned to the fact that illegality brings with it, if you will, a certain level of being guarded. Clients or patients might not be as forthcoming or open about their experience, about their feelings, about their wants, their needs. I think that kind of guarded response is rational, but it may appear to somebody who isn’t taking that into account as something that’s, in the old parlance I guess, a resistance. I think you have to understand it from the point of view of someone who has an illegal status and the way that it changes their behavior really.

Patrick Verel: When it comes to your ethical responsibility to offer care, I would imagine that there is no distinction though.

Gregory Acevedo: Oh, of course, yeah. I think clearly morally I don’t find a distinction. It’s a technical issue, first of all legally. It’s an issue that’s important in terms of understanding, as I said earlier, people’s behavior. But I’m very clear about my … you’re here to serve everyone, right? So it’s the idea that you don’t make those distinctions. Clearly, from a human rights framework, which I think is very important, those aren’t distinctions that have any validity when it comes to receiving treatment.

Patrick Verel: Anti-immigrant sentiment is not a new phenomenon in this country, of course. Are there any lessons from the past that you incorporate into your work?

Gregory Acevedo: I teach courses on advocacy and policy practice. I use the example actually of the Immigration and Nationality Act of 1965 because it really offers a great lesson on time, if you will. That act actually undid the racialized national origins quota system that we had in place since the early 1900’s in U.S. immigration policy. It took decades of political effort and social cultural change to really undo a deeply entrenched nativism that informed that national origins quota system that we had.

When I teach a course content on policy and advocacy work, I always emphasize the long view and the importance of the long view. There’s a sentiment that was expressed centuries ago by Rabbi Tarfon, I now share with my students, “It’s not your responsibility to finish the work of perfecting the world, but you are not free to desist from it either.”

The idea is that you’re probably not going to see that change that you’re looking for immediately, maybe even in your lifetime, but that shouldn’t lead to cynicism, pessimism or walking away from the work. You have to stay in that work for the long term.

Patrick Verel: The thing that keeps coming up is this notion of the fear of the other. It’s something that is, like I said, it’s not new. We experienced before. It seemed like we sort of got a little over it. Now we’re right back where we started it seems like. Any idea why?

Gregory Acevedo: One of my favorite scholars in this area, when he writes about actually the history of the war on poverty. There’s this big debate, the war on poverty was a success, was it a failure, et cetera. I think he reframes it in an important way where he says, “History, U.S. social policy history is really a continuing history of reform and reaction.” It really is this like a few steps forward, a few steps backwards and maybe in the long rhythm of time, you’re moving forward. But we truly, we have these regressive periods where we really do turn the clock back and, unfortunately, return to some past ways of thinking and doing. They’re never fully gone. There’s always some tinge of nativism that’s out there.

Then global events and other events and national kinds of currents change and it sparks up and it’s back again. You can say this about almost any major policy issue in U.S. History. There’s a quote I use a lot in class. I think it was Karl Deutsch from the Harvard School, Kennedy School of Government. He talked about how U.S. social welfare policy history follows the random walk of a drunkard. They think they’re moving forward, but they’re stumbling from side to side. Sometimes they’re even moving backwards. They might fall on their face. They have to get back up again. It is, it’s one of those times when I think we’re taking a great step backwards unfortunately.

Patrick Verel: When you talk about the work that you’re doing, how much of that is discussed, this notion that, “Okay, we take two steps forward on this issue, but sometimes we take one step back”?

Gregory Acevedo: I mean, I think it’s almost natural that that topic comes up. It’s based really on a generational point of view. If you’ve been around a while, you’ve seen these things before. Many of my students are younger. They weren’t even born during the Reagan years. Yet, I see many parallels between the Trump administration and the Reagan administration. I think that is just naturally in the minds of many folks who do this kind of work. It’s that idea that we’re still working on Dr. King’s Dream. You really have to be vigilant. This work has to be ongoing ’cause it’s so easy to slip back and go back to an earlier period.

Extra Track

Patrick Verel: It’s been estimated that between 114,000 and 213,000 Puerto Ricans will move to the U.S. mainland over the next 12 months as a result of the devastation of Hurricane Maria. I would imagine many of them will move here to New York City. What should those in social services working with that population be paying close attention to?

Gregory Acevedo: I think some of the central issues are trauma, which, thankfully, these days in terms of providing particularly mental health services, has become an important aspect of how we think about how we do our work. These days, many things go under the moniker of trauma informed or practice, for example. This idea of trauma, I think social workers and mental health practitioners, many of them will have that already in their toolkit and to recognize that there is layers of trauma involved here. There is the trauma of the actual hurricane and the devastation and dislocation of that. There is the trauma of the reaction of the United States and the lack of provisioning and care and the kind of like dealing with the crisis once the hurricane happened. Then there’s the trauma involved of being uprooted, having to move perhaps when you didn’t want to, relocating to a place that you hadn’t even planned for. There’s a big thing in the literature on migration that the longer you have to plan and the better the plan and preparation you have to migrate, the more it lowers the stressor involved in migration.

Being unprepared, being dislodged, having to do it without doing it voluntarily but involuntarily, I think the level of trauma is really high for a lot of Puerto Ricans. Then there’s the continuing kind of traumatic experience of almost being shunned and ignored by your own country, which I think is shameful. I think that that’s very real to many Puerto Ricans and yet for many Americans who are not Puerto Ricans, I don’t think it’s something they fully fathom or understand.

And there’s the concrete services that are needed. Places to stay that are long-term, not just sheltered. If people want to relocate and stay for a long time, what are they doing to need? Connecting up with schools, with other services that are needed.

I really do think it’s being attuned to the fact that there’s going to be this need for these concrete services and there’s going to be this need for the mental health and behavioral aspects that are involved. I think that’s what mental health practitioners probably need to be most attuned with when it comes to working with Puerto Ricans who’ve been basically dislodged by the hurricane. It’s kind of like an exile of sorts where you’re not quite sure when you can go back, right? And so, when will Puerto Rico be up and running again? I mean, it is for some folks, right? It’s like anywhere else where if you’re probably in San Juan and some of the more urbanized areas, things are probably better off than if you’re elsewhere. Of course, those who have already had more resources and privileged are probably doing better than those who don’t. I think that’s another thing that we need to account for. There’s a certain type of Puerto Rican migrant that’s going to come to the United States, and its a lot more about issue of resourcing than anything else.

If you enter the office of the congregation, a big golden retriever might greet you with a stuffed animal while Alpha, the congregation’s betta fish, wiggles by in a tank nearby. A garden walkway is a sanctuary for wandering minds. The church also offers yoga classes to members of the Newtown community. 

But the classes are less about learning how to perfect a Downward-Facing Dog and more about providing a portal for trauma recovery, said Crebbin.

“The feeling of trauma—the depths of it—is that ‘my life is never going to be the same,’” he said. “If you have this image that ‘I’m going to be healed or I’m going to go back to the way my life was,’ that’s not helpful because people will never get there.”

Crebbin reflected on the 2012 massacre of 20 Sandy Hook Elementary first-graders and six school officials, at Calming the Chaos: Clinical and Pastoral Responses in Traumatic Times, a pastoral conference organized  by Lisa Cataldo, Ph.D., assistant professor of pastoral counseling, and Mary Beth Werdel, Ph.D., director of the pastoral counseling and spiritual care program at the Graduate School of Religion and Religious Education. The March 2 event also featured certified trauma professional and Fordham adjunct professor Cheryl Fisher, Ph.D. The goal was to provide strategies for trauma care.

“It’s like you have a broken leg that has never quite healed right, and so you always have a limp, but you learn to dance with the limp,” Crebbin said, paraphrasing a quote from bestselling author Anne Lamott. “I think those images are more helpful to us than images that suggest that life will return to normal.” 

First Responders of Trauma

Roughly two weeks after the Feb. 14 shooting rampage in a Parkland, Florida high school claimed the lives of 17 people, Crebbin stressed that simply being present for people who are traumatized can be transformative.

“Over time, there are ups and downs, but slowly we find ourselves somewhere down the path to new wisdom [or]a life where the trauma hopefully for the community is integrated in such a way that there isn’t a denial of what happened,” he said.

Fisher, an advocate of nature-based interventions for trauma treatment, cautioned practitioners, as first responders to trauma, not to neglect their self-care.

“When we [ourselves]are overwhelmed, we silence the responses of our clients, patients, and community because we can’t take anymore,” she said. “If we ever had an argument for self-care, that’s it. If we’re not taking care of ourselves, we run the risk of dismissing their stories and causing harm to them.”

Activism in Traumatic Times

Taking on an activist role has helped some Newtown parents and community leaders to reclaim their power, said Crebbin. Some residents have joined gun reform coalitions while others have established foundations in memory of their children.

The Parkland teens have taken their activism a step further, he said, with a televised gun control rally shortly after the shooting, as well as a forthcoming March for Our Lives protest and nationwide walkout for gun reform.

“The response [to mass shooting]has changed from Newtown,” he said. “People were reflective. Now, people are angrier [because of]the lack of change,” he said.

Pastors and other spiritual leaders have also been called to take their ministry beyond the pulpit.

“Prayers are not nothing, and action is everything,” said Fisher. “We have to get out of our offices, off of our chairs, and take action.”

Crebbin argued that gun violence in communities of color should also be a national concern.

“If you’re only paying attention to [Newtown and Parkland] then you’re not paying attention to the ongoing issues of trauma,” he said.

 Finding Light in the Cracks

 Fisher proposed several nature-based exercises for communities ravished by trauma, including yoga, bird watching, gardening, nature walks, and bonding with animals.

Through her work, she found that these practices can create “natural examples of awe, wonder, and hope.”

“When I sit with clients and hear their stories, my role is to be a vessel,” she said. “I’m not expected to have the answer. What I do know is that at the end of the day, there is a tomorrow.”

Crebbin said in spite of the Sandy Hook tragedy, there isn’t a “dark cloud” that sits over the Newtown community.

“We have hope,” he said. “We’re trying to be a little more authentic. We admit that we’re cracked, but we admit that there is light that gets into those cracks, and I think that’s a gift that was given to us.”

“Psychoanalytic Perspectives on Trauma: On the Fragmentation and Restoration of the Human Soul,” is being sponsored by the Graduation School of Education.

Friday, April 21
8:30 a.m.–4:30 p.m.
McNally Amphitheatre
140 West 62nd St, Lincoln Center Campus

Amelio D’Onofrio, Ph.D., clinical professor and founding director of the Psychological Services Institute at Fordham at GSE, said the conference’s presenters will talk about how relational trauma in particular, shatters our “souls” and uncovers a history we have often concealed from ourselves.

If, for example, a person grew up in a family with substance abuse, or one of their parents was unable to give proper care because of mental illness, the trauma from that experience might make it more difficult to recover from later-life traumas.

“Many of my patients come in, and early on they’ll say ‘I had a perfect childhood; everything was great!’ But as the work continues, we’ll start to entangle traumatic experiences that they may have had, and that are now reactivated by the breakup of a relationship, for example,” he said.

Topics being presented include “Psychotherapy’s Epic Journey: Descent, Dismemberment, and Remembrance;” “Built On A Lie”: Perversion in an Everyday Subject and Donald Trump;” and “Conversion Disorder: Colonial Trauma and the “Souls” of the Barrio.”

D’Onofrio will present one session, “Desire, Despair, and the Presence of an Absence: Relational Trauma and Therapeutic (Re-)Enactments.” He said the thesis of his presentation is that early life traumatic patterns can play actually out in the relationship between patient and therapist. A patient who has never been on the receiving end of an empathetic gesture might not be able to respond to one when a therapist is there for them. This, he said, can sometimes trigger a negative therapeutic reaction.

Presenters were chosen because they represent a diversity of ideas, he said.

“Betsy Hall, a professor and assistant dean of counseling and family therapy at Regis University, is a Jungian who deals with psychoanalysis, myth, stories, and literature. Patricia Gherovici, who is a psychoanalyst and co-founder and director of the Philadelphia Lacan Group, works with poor Hispanic populations in Philadelphia and comes from a Lacanian perspective. Ed Robbins, a clinical psychologist, psychoanalyst and clinical director of Dr. Robins & Associates Trauma & Treatment Center, is a Freudian and works with the trauma of violence,” he said.

“Having different theoretical orientations and different voices in the conference will make it a richer experience for the audience.”

For more information, visit the conference webpage.

This is the challenge that Virginia Strand, D.S.W., co-director of the Graduate School of Social Service’s (GSS) National Center for Social Work Trauma Education and Workforce Development (the Center), has accepted.

In 2012, the center received a $2.4 million grant from the Substance Abuse and Mental Health Services Administration (SAMHSA) to pursue an ambitious multipronged education program aimed at changing the way social workers treat children, adolescents and their families suffering from trauma.

Four years later, Strand said she’s happy with how her staff both introduced a new trauma-related curriculum and helped agencies provide field instruction to social work students in the evidence-based trauma treatments.

The Center recruited 65 schools of social work to teach a course that Center faculty developed on trauma to nearly 5,000 students. Data from evaluation surveys they took afterward were encouraging.

“We were able to see that in fact, students emerged feeling much more confident about their knowledge and ability to intervene with traumatized children and their families. It was exciting that we were able to disseminate this so broadly and have it be successful,” she said.

The Center also trained the faculty of six schools of social work (and one partner agency at each) in how to implement evidence-based trauma treatments. The schools used an implementation science framework to help a partner agency implement evidence-based trauma treatments.

The challenge going forward will be locating funds for the necessary training.

“Most evidence-based treatment developers will tell you that it takes both a two-day orientation, plus six to 12 months of weekly to biweekly consultation calls to really learn a model,” she said. “It’s very difficult for agencies to free up staff and get funds for that training time.”

Money is likewise an issue when it comes to treatment. Evidence-based treatments for children recovering from sexual abuse and domestic violence often require activities that are not yet reimbursable by insurance.

“Clinicians  may need more than one-on-one sessions with the child; they may also need sessions that include parents or other family members, because they’re trying to implement a particular model,” Strand said.

Part of that model is recognizing that children who grow up with chronic exposure to abuse and neglect have difficulty forming attachments in adult life. They can then become socially isolated, and become trapped in a vicious cycle.

Strand said new treatments have emerged in part because researchers have a better understanding of how long-term exposure to trauma alters the development of a child’s brain. Studies have shown, for instance, that children who’ve been abused and neglected have a smaller than normal hippocampus, an area of the brain that helps store and categorize memories. This makes it harder to concentrate and memorize, so they do poorly in school.

“New information about how the brain is affected by trauma has helped people understand how serious the impact is, why it’s critical to intervene, and why it’s so important to use these trauma treatments,” Strand said.

Another challenge that trauma victims face is continued stimulation of the midbrain, via their “fight, flight or freeze” responses to traumatic events. Cortisol levels that would normally decrease after stressful events have passed instead stay at high levels, making them more reactive to eventsin the current environment.

“A lot of behavior that we see with adolescents who seem to be out of control has to do with being triggered by something in the current environment that pushes them into the past, and they’re reacting out of their past emotional experience, not in response to what’s in the present,” Strand said.

“People who aren’t trained in trauma just see kids who are bad.”

The SAMHSA grant ends in October 2017. Going forward, Strand wants to explore the field of implementation science more fully.

“After a point, you know something is working because you’ve done enough research,” she said. “The real challenge is, how do you move it into community practice? It’s one thing to be well funded, and work in whatever “lab” or community setting they’re tested in,” she said.

“But how do you generalize that? How do you get that best practice to be used more broadly? That was a big part of what we’ve begun to do.”

Days later, many people are still struggling to cope with news of the tragedy—even those who were not directly affected. That struggle is not uncommon, said two Fordham experts on stress and trauma; personal or geographic distance from the tragedy will not necessarily spare people from intense grief or even trauma.

“Acts like this pull the rug out from underneath us,” said David Koch, PhD, clinical associate professor at the Graduate School of Social Service. “When something like this happens—losing 50 people at once in a violent act—you don’t have the traditional tools available, so how do you manage it?”

Few of us know what to do or how to act following such atrocities, because, until recent years, recurrent mass gun violence has not been part of our realities. In the aftermath of Newtown, Aurora, Orlando, and others, Koch said, we’ve come to realize we have no idea how to make sense of the fear, anxiety, anger, and sadness that these shootings have triggered.

Moreover, the near-constant stream of news coverage on media outlets and social platforms keeps us immersed in the unfolding tragedy. The exposure may trigger in some people a secondary grief reaction, said Mary Beth Werdel, PhD, an assistant professor of pastoral counseling at the Graduate School of Religion and Religious Education.

If that feeling of grief is accompanied by more intense physical and psychological symptoms—for instance, intrusive thoughts or memories about the event, hypervigilance, feelings of anger or sadness, or sleep or appetite disturbances—then one may also be experiencing a trauma reaction.

“When there is a mass shooting or terror attack, one may be a survivor, may have witnessed the attack live, or may be witnessing it through repeated media exposure,” Werdel said. “It is possible to have trauma reactions as a result of any of these experiences. The impact is dependent upon a number of factors, including previous trauma and loss experiences.”

In cases of traumatic grief, it is often necessary for people to seek a licensed social worker, counselor, or psychologist who specializes in trauma, Werdel said.

“Trauma… shatter[s]a person’s assumption of safety and may result in experiences of vulnerability and fear,” she said. “The work of the individual, then, is to rebuild.”

Koch, who specializes in the mental health of lesbian, gay, bisexual, and transgender individuals, said in the days following the Orlando shooting, that sense of “shattered safety” has been felt widely among members of the LGBT community.

The question, then, is how do we cope?

“You first have to acknowledge that your typical ways of coping have gone out the window and you have to figure out new ways in the face of this much trauma—cognitively, intellectually, and emotionally,” Koch said.

“I cope by trying to be in touch with what I’m feeling and to use ways of coping that have worked before to help manage feelings. I slow down, do some meditation, take my foot off the accelerator a bit and try not to get too agitated.”

Most important, he said, is to use social supports.

“In the face of this kind of hate, we need to reach out to and take care of one another—to provide those social networks… so that we’re not alone,” he said. “That collective action can serve as a kind of buffer against the hate… It also helps combat feelings of helplessness.”

In time, it is possible for people to move through and even grow as a result of tragedy, said Werdel, who researches post-traumatic and stress-related growth. There are several factors associated with experiencing this type of growth, she said, including personality traits of optimism and openness, social support, positive religious coping styles and faith maturity.

Growth, however, takes time.

“When we consider post-traumatic growth or stress-related growth, we must remember the importance of pace. By this I mean that we don’t look for growth experiences too quickly,” Werdel said.

“The image of ‘growing strong in our broken places’ that Hemingway wrote of is often considered when thinking of post-traumatic growth—it takes time. It is not immediate. We must also remember that growth is not in place of stress or trauma reactions but rather often coexists.”

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Earlier this fall, Lisa Cataldo, PhD, an assistant professor of pastoral counseling in the Graduate School of Religion and Religious Education, ran a workshop for a group of interfaith clergy in Newtown, Connecticut in anticipation of the third anniversary.

“In any community that suffers a massive event like what happened in Newtown, faith groups are often the first place that people turn for consolation and connection,” said Cataldo, who is a practicing psychotherapist.

“The workshop was about dealing with the aftermath of a communal trauma over the long term, because when anniversaries come around, all sorts of memories and emotions get reawakened.”

Three years later, Newtown is working toward healing while also dealing with continual reminders of the trauma whenever a new tragedy occurs, such as the shootings in San Bernardino and Colorado Springs.

But the families of Newtown—as well as the victims of the latest wave of mass violence—are not the only ones whose grief is magnified at this time of year, Cataldo said. For many of us, the holiday season brings up poignant reminders of people and places we’re missing.

“People think they’re supposed to be happy during the holidays. This is supposed to be a time of sharing with your family, of positive relationships, of celebration and joy,” Cataldo said. “Many people feel alienated, because they’re not in that space, and that idealized image of the holidays only makes them feel the lack of those things more acutely.”

Even if one gets beyond the “shoulds” attached to the idealized holiday season, there still remains the stark reality that someone or something has been lost.

“This is true for people who are in the midst of active mourning, but also for anyone who has experienced loss,” Cataldo said. “On holidays, the absence of the people we’ve lost is louder.”

Coping With Grief During the Holidays

The holiday season presents a challenge for many people, Cataldo said, but not everyone is open about his or her suffering. One reason for this is that our society tends to overvalue strength and resiliency, leaving little, if any, any room for vulnerability.

The key to coping with holidays, anniversaries, birthdays, and other difficult days is to make room for the grief, rather than shutting it out.

“We put pressure on ourselves to be strong when what we really need is to be more compassionate toward ourselves—to say that I need more time, that I’m not okay yet,” Cataldo said.

“Many people fear, ‘What if I can’t handle the holidays?’ The thing is, you don’t have to. It’s perfectly okay to say that you need to take this year off, that you can’t engage in these types of celebrations right now.”

For some people, she said, it can be helpful to deliberately include the loss into holiday rituals and customs. This might involve creating new traditions that honor lost loved ones, such as going to a certain religious service or writing a letter to them.

“It’s important to support people in moving through this time in the way that is best for them,” she said.

A New Normal

Holidays also serve as cues to reflect on the previous year. For those who have experienced hardship and heartbreak, the resounding question at these milestones is, “When am I finally going to be okay? When will I feel normal again?”

The reality is that there might not be a return to normal, Cataldo said.

“Any kind of significant loss creates a new normal,” she said. “Things won’t go back to the way they were before the loss, because life has changed.

“But it is absolutely possible to feel okay again. The memories won’t always be a source of pain—they might one day be a source of comfort and connection. Life won’t look the same, but it can still be wonderful.”

Taking time to deal with the stress and anxiety that accompany helping professions is imperative, said Robert J. Wicks, PsyD, at the Graduate School of Religion and Religious Education (GRE) on March 6.

“Severe secondary stress is dangerous,” said Wicks, a professor of pastoral counseling at Loyola University Maryland and an expert on secondary stress and trauma in caregivers.

“For every case of someone who is experiencing severe secondary stress, there are a least a dozen others on the edge of some form of secondary stress.”

Wicks told an audience of chaplains, therapists, and students of pastoral care and counseling that secondary stress is a reality they must face within their chosen careers. Also called vicarious trauma, this stress is a kind of “emotional residue” that comes from constantly witnessing pain and suffering.

“We run the risk of catching others’ sense of despair,” he said.

Wicks headlined a GRE conference that borrowed its name from his bestselling book, Riding the Dragon: 10 Lessons for Inner Strength in Challenging Times (Sorin, 2003). He discussed five red flags that portend burnout and secondary stress:

1. Becoming over-involved in others’ emotions: Empathy is vital to establishing rapport with patients or parishioners, said Wicks. However, mental health professionals and ministers must avoid becoming emotionally entangled in patients’ distress. Otherwise, counselors and clients alike will be incapacitated by their pain.

“The seeds of caring and the seeds of burnout are the same seeds,” Wicks said.

2. Acute secondary stress: No matter how much care one takes to maintain an appropriate emotional distance, this isn’t possible 100 percent of the time, he said.

He recalled a recent session when a patient was recounting the horrors of war she endured. Before he knew it, Wicks found himself gripping the arms of his chair.

“I do darkness for a living, yet I find that if I let my guard down, I’m in trouble,” he said.

3. Chronic secondary stress: Wicks said that communications theorist Marshall McLuhan once posed the question, “If the temperature of the bath rises one degree every ten minutes, how will the bather know when to scream?”

“Many of us don’t know when to scream,” Wicks said.

Members of helping professions hold themselves to high standards, expecting to care for all people all the time, he said, while also balancing a heavy workload.

It is imperative to practice self-care as a means to deal with the stress, anxiety, and even trauma that one inevitably experiences in this profession.

4. Getting caught up in colleagues’ anger, hurt, and fragility: Every parish or clinical setting has jaded employees, said Wicks. These people deserve compassion, because their anger is often a cover for deeper pain. However, he cautioned that helping professionals should not “give your joy away” to them, or else they risk contracting their negativity.

5. Confusing the “five levels of critical”: A surefire route to burnout is mismanaging priorities, Wicks said. He advised organizing work and life according to five levels:

• Critical now: urgent tasks and situations
• Critical in the long-run: self-care, maintaining friendships, etc.
• Critical for others: tasks and favors others ask of you, which you must triage according to your availability and limitations
• Not critical: the overflowing email inbox, the pile of papers on your desk—these must be done, but they can be “zipped through” to get them out of the way
• Critical not to do: tasks you decide ahead of time you will not do—in other words, boundaries. “Be aware of [your boundaries],” Wicks said. “If you give in when you’re exhausted, feeling unappreciated, or experiencing stress… you’re going to hurt yourself and someone else.”

But what if the trauma is not a one-time event? What if a person’s entire world is filled with adversity, flooding her with constant stress and anxiety and preventing her brain from ever recovering?

This the challenge that underlies the treatment of complex, or chronic, trauma, says Amelio D’Onofrio, Ph.D., a clinical professor and director of the Psychological Services Institute in the Graduate School of Education (GSE).

In general, a traumatic experience is one that is so distressing that it overwhelms the brain’s ability to process the event and triggers a set of survival-oriented physiological and psychological responses. Acute trauma refers to a singular event such as a car accident, an assault, or a natural disaster. Complex trauma, though, is more pervasive.

“For instance, if a parent chronically abuses substances and cannot meet a child’s basic needs, that is a traumatic environment for the child. Or if there is violence in the home or in the neighborhood and kids are constantly trying to protect themselves, that is traumatic,” said D’Onofrio, who is also a practicing psychotherapist.

“We expect kids to focus on doing schoolwork and solving complex problems, but they’re so worried about self-protection that their nervous systems have been activated to the point that they can’t focus.”

This year D’Onofrio received a $311,000 grant from the Department of Health and Human Services to design an intervention program for inner-city students who have experienced complex trauma and who otherwise would not be able to receive specialized psychological services.

The grant-funded program, which was implemented in two Bronx middle schools this fall, is divided into ten-week increments over the course of two years. For each set of ten weeks, doctoral students from GSE’s counseling and counseling psychology program run structured group treatment with at-risk students. The team also meets with each student individually at least twice and meets with parents to educate them on the effects of trauma and how it impacts their children.

The goal is to help students start to understand the impact of stressful and traumatic environments and to teach them healthy coping skills so that they will be less likely to turn to gangs or drugs.

“We worked closely with GSE’s Center for Educational Partnerships to select the two schools. One of the schools is serving many recent immigrants from all over the world, and the other school recently had a gang-related stabbing,” D’Onofrio said, referring to an incident this summer in which a 14-year-old student stabbed and killed another student outside their middle school.

D’Onofrio hopes to later develop internships and externships in the schools so that Fordham counseling students can continue working with the middle school students once their ten sessions come to an end.

“I think this a powerful interface between a Jesuit university and the community, a way of giving back and working toward social justice,” he said.