This page is written both for survivors and for those of you who are close to a survivor.  
 

We will look at elements that may assist survivors in taking the first steps to move on in life. We will look at different forms of help, at what trauma is and how it may affect the body and the mind, and common trauma reactions that people may experience after severe abuse. This knowledge may give a sense of control and provide some hope for the future, both for survivors and those of you who are supporting a survivor.

The rehabilitation and healing process after having experienced severe human rights violations may take different forms for different people. It also depends on the context and the support the survivor may receive. Some survivors recover relatively quickly and experience less trauma related reactions after a couple of weeks or months. Other survivors may have trauma related reactions for a longer time, sometimes many years or even their whole life. Often, reactions become less strong with time, and many survivors will experience moments in their life with little or no trauma related reactions at all. Sometimes reactions can disappear and then come back again. They can manifest themselves in different ways, in the body and/or in the mind. The most important thing to remember is that the survivor is not crazy! These reactions are common reactions to trauma.  

Mental Health and Human Rights Info

We work from a human rights perspective, and something that we find particularly important is that survivors will always be themselves and that nobody, ever, can take that away from them. Nobody can take the dignity away from the survivor.

We have divided this part in the following way: 

I. Different forms of help 
Support from family and friends 
Support groups Therapy  

II. Trauma and trauma reactions: understanding survivors’ reactions and providing hope 

I. Different forms of help 

Support from family and friends   
Sometimes the best form of support is the support that we can receive from people who are close to us. Knowing that they are there for us, that they love us, believe, and respect us and want what is best for us can be a great source of strength. This means that you, as a family member, partner or friend of the survivor, are in the best position to support the survivor towards moving on in life. In this sense you are already well equipped to support the survivor; sometimes it is enough to just be you and to be there for the survivor.

Making it clear to the survivor that you are there for them – that you “see” them, listen to them, acknowledge their pain, care about them, respect and value them, are good ways to provide support. 

Receiving support does not necessarily mean that survivors need to tell people what happened to them. There can be many reasons why survivors do not want to talk about what happened, it can be too difficult, painful, survivors may want to protect people from the horrible story and sometimes it is even dangerous to tell someone about what happened. It is always the survivor who decides whether he or she wants to talk about what happened and what he or she wants to tell about it.  

If the survivor decides to tell you what happened, or parts of it, make sure to demonstrate that you believe what the survivor says and that you never put any shame, guilt or blame on the survivor. Remember that perpetrators are the only ones guilty and that human rights violations are illegal. The survivor has survived a crime perpetrated against him or her. 

In many cases, there are other ways in which people who are close to a survivor may provide care and support. Making sure that the survivor is as comfortable and safe as possiblerespecting the survivor’s needs and reactions, and being there for the survivor are good ways of showing love and support. You as someone who is close to a survivor can assist the survivor in creating a relatively “safe place” (meaning that you feel relatively safe when you are together) and that you try to focus on the here and nowthat you use your senses to feel present in the current moment. One way of doing is, is to practice grounding exercises together, which can also be beneficial for people who are close to survivors. You can find more information about how to do this under the heading Self-care: grounding exercises. It is always the survivor who decides if she/he wants to practice grounding exercises or not. 

In order to be able to care for and support the survivor, it may be helpful to know a little bit about what type of mental and physical reactions that are common among survivors. Severe abuse, especially when life-threatening, can seriously harm a person in various ways. The person you are close to who has survived severe abuse, may seem different from before – like as if the person is not entirely herself or himself. The survivor may, among other things, experience an acute stress reaction (which may last some hours or days after the abuse), deep sadness, have nightmares or bad dreams, frightening thoughts, flashbacks (meaning that the person feels like the abuse is happening again), dissociation (meaning that the mind of the person “leaves the body”), avoidance symptoms (meaning that the person avoids anything that might recall memories of the traumatic event), depression (a lack of energy and deep feeling of sadness, meaninglessness and/or lack of hope for the future) anxiety (feelings of strong fear), and/or be physically injured or have pain in different body parts.  

It is very important that you are patient and respect the survivor’s fear and withdrawal. Openly accepting that the survivor reacts in such ways is very important. Keep in mind that most of these reactions usually are temporary and are a consequence of the abuse. The reactions are common reactions and the survivor is not “going crazy”. 

It is important to understand that reactions vary from person to person, and that they may also vary over time. Maybe the survivor has various symptoms or reactions in the beginning, then for a while seems to be coping well, and then some months or even years later symptoms or reactions come back. And sometimes reactions may change over time. Give the survivor enough time and be patient. Healing and recovering from severe abuse and trauma may take a long time.  

In general, it is very important to let the survivor decide how you can support him or her. Letting the survivor make as many decisions herself or himself as possible is very important for restoring the survivors’ dignity and integrity, and a sense of control in her/his own life. 
 

Support groups

Sometimes support groups may be available in the local community of the survivor, or somewhere in the broader community where the survivor can receive support. Often these are organized by NGO’s and social and / or primary health care services. Support groups are often available free of charge and may be available for an extended period of time.  
Support groups may offer different forms of support, such as support in dealing with trauma reactions, as well as social, financial, judicial, and housing support.  

The stories from Rwanda and Chile that we provide on this page provide some more information about what support groups may look like. You can find this under the heading Examples from different countries: Rwanda and Chile. Also, under Organizations and sites you can find information about organizations and web pages that give more information about different support groups.  

Therapy 

Therapy is a form of psychological support with a mental health specialist, either a psychologist or a psychiatrist. There are different forms of therapy that have demonstrated to be effective for treating trauma reactions. Therapy is often on a one-to-one basis, between the survivor and the therapist, but sometimes group therapy may also be an option. Therapy may last for a shorter or an extended period of time, sometimes many years.  
In most countries some form of therapy may be available somewhere in the country, but unfortunately it is not uncommon that there is a huge lack of specialist mental health professionals who can offer this type of support. Perhaps you can consult with somebody you trust, for example a social worker or primary health care worker, whether there are options for therapy available to you?  

II. Trauma and trauma reactions: understanding survivors’ reactions and providing hope 

It may be helpful to know a little bit about trauma and what type of mental and physical reactions that are common among survivors of severe human rights violations, both for survivors and for people who are close to a survivor.

Information about how the brain works and why we as human beings react the way we do in traumatic events can be useful. This may provide the survivor with the knowledge and ability to deal with her/his problems in alternative ways. Knowledge means that the survivor understands what traumatic events may do to a person, what she/he may expect and is aware of the reactions she/he may have. We believe that the more a person is aware and knowledgeable about her/his problem and how it affects her/his life and the lives of others, the more control she/he can have over her/his life and the better the person can deal with and live with the reactions. In this way, information about trauma may empower both the survivor and you as a person who is close to a survivor.  

‘Trauma’ means wound. In both medicine and psychology, it refers to major physical or mental injuries, including threats to life or physical integrity.  

Some key things to know about trauma:  
-The situation is overwhelming, inescapable and very frightening  
-Threaten life and integrity  
-Loss of control and beyond what we are prepared to deal with  
-Most people will struggle with serious reactions such as intrusive memories, re-experiences, flashbacks and sleeping problems afterwards  
-Suffering can be recognized in thoughts, feelings, breathing, heart and body 

‘traumatic event’ is one that has the capacity to cause mental or physical trauma. Faced by such an event, the immediate response of the body and the mind is to struggle for survival. Behaviorally this is expressed by ‘fight, flight or freeze’ responses, submission or ‘playing dead’. A severe traumatic event often changes the way in which survivors understand the world around them. They may lose their sense of safety and feel vulnerable and helpless. If the event involves acts of violence and the intention to hurt, trust in other people may be lost and the survivor’s relationships with others seriously disturbed. Personal encounters with human or man-made violence are considered the most disturbing forms of trauma, likely to have the most lasting impact.

Loss of safety, control and trust commonly leads to depression (deep sadness, loss of the will to live, etc.) or anxiety. It is important to emphasize that the reactions that survivor experience are “normal” reactions to an abnormal event. The survivor is not crazy!  

Some important things to know about acute trauma:  

  • When a person is traumatized, her/his feelings are intense and chaotic 
  • Fear and shame may cause a survivor to withdraw and refuse social contact 
  • Trauma cases a survivor’s confidence to collapse 
  • It is important to act but, at the same time, you as someone who can support the survivor, must allow the survivor to decide at what point she/he is ready to make contact and open a conversation 

Flashbacks are sudden, often strong, and uncontrollable re-experiences of a traumatic event or elements of that event. Survivors may feel disconnected from their bodily sensations and feel numb or may be unable to recall traumatic memories. A state of heightened arousal is also quite usual. Survivors may be on their guard all the time, startle easily, sleep poorly, be irritable, or find it difficult to remember and concentrate. A personal encounter with violence and death may also haunt the survivor, who may painfully re-experience the event in dreams or daily life (also called intrusion). We call the reminders that cause intrusion ‘triggers’. 

Triggers, or trauma-reminders, are events, objects or situations that remind survivors of their painful experiences and memories. Such reminders may elicit trauma reactions over and over again. They can be extremely distressing and create such anxiety that people are afraid to go out, see people, hear certain sounds, or do many ordinary usual things.  

Some key points to know about triggers: 

  • Unexpected situations can suddenly trigger trauma reactions 
  • It is possible to prepare against these, by using the senses to feel more present 

Calming a survivor who has been triggered:  

In order to help a survivor, it is useful to assist her/him in coming back to the here and now. You may say things like this to the survivor:  

  • “You are at home/a café/in a park (or where you are at the present moment) now” 
  • “You are safe here in this room” 
  • “You are here now and not where the traumatic event happened” 
  • “You are strong and courageous” 
  • “Remember to breathe” 
  • “Look around, try to be present here and now” (for example, you can point at different objects in the room and say things like “Do you see the white table over there? Do you see the green carpet? The yellow chair?”)

You may also practice grounding exercises together and try to use them if/when the survivor is being triggered.  

We have now provided you with information about how trauma and traumatic events may affect the body and the mind. We hope that this information will be helpful in understanding your/the survivor’s reactions better. We have also given some information about how to calm a survivor who has been triggered.  

The grounding exercises that we have described under the heading Self-care: grounding exercises explains how practicing grounding exercises regularly, either alone or together, may help the survivor to deal with traumatic memories, triggers, flashbacks and nightmares if they occur. We therefore recommend that you have a look at the page with grounding exercises and try some of them. Maybe this can be helpful in handling the trauma reactions, making good decisions for oneself and others, and take some control back in life.  

Remember that, with time, most survivors will get better. Also remember that nobody can take your dignity away from you.  You are you.