Opening the Heart in Hell - on learning from the Omagh bombing.
Introduction
"Generally the literature has focused on pathological adjustment and testifies to the severity and chronicity of distress often experienced by survivors of traumatic events. But there are often positive psychological reactions following trauma such as an increased ability to appreciate life and to show more compassion towards others"
(p. 47 Joseph et al 1997)
In this paper I am exploring the nature of my response to my involvement as a counsellor in the trauma team that supported those bereaved by the bomb in Omagh in the "immediate impact phase", the hours following the bomb blast up to the point at which the bodies of the those killed in the bomb where identified. Ultimately it is a journey which has lead to increased compassion and a deeper appreciation of life but it has also involved "the intense work of opening our heart in hell" (Stephen Levine 1987) and my experience leads me to believe that these two aspects of the process are inextricably linked.
Being there
I was standing in my father's living room telling him that I was taking my daughter to the swimming pool when the blast shook the house. It amazes me still that I drove to the leisure centre and it was only when someone told me that it was closed to deal with casualties from the bomb that the connection was made between the sound and its meaning. As I write now, nearly two years later, I still feel distress that I could do such a thing. It doesn't matter how many times I tell myself that it was shock; that it actually makes no difference in the great scheme of things; that I just couldn't take in the enormity of what had just occurred; I still feel guilt and shame.
I decided to go to the hospital and volunteer. I hoped that there was something that I could do. I have fifteen years experience of working as a counsellor and am trained in both crisis intervention and bereavement counselling. I had no idea if I would be accepted, only that I was clear that if there was anything I could do I wanted to do it.
In the hospital, there was pure chaos. The whole place palpitated with the distress of the milling people searching for the loved ones they had lost. My first job was to keep a corridor clear so that they could bring in the injured who were still arriving by taxi and ambulance. I'd volunteered as a counsellor but what I had to do was yell in people's faces "You can't go down here!" and every so often slap myself up against the wall so that they could wheel in trolleys of people, some weeping and bloody, some eerily silent.
Later I went with the team of volunteers to the leisure centre and spent the night working with one of the families bereaved by the bomb and had many encounters with others so bereaved. There! It can be said in a sentence but it is a different matter to say what it was actually like.
"A different horror than the frenetic movement of 'Nightmare 1: The Hospital'. No, this dream was one of waiting, waiting, hours of waiting. Every so often a microphone was turned on and a still hush descended as they called out a list of names - people injured and found in another hospital... Around midnight, I think it was - as Saturday became Sunday - they called a gathering of all those who still had people missing. What I didn't know then but grew to know, was at that point, all those people did not have loved ones missing but loved ones dead....
And oh, this third Hell was most Hell of all. The nightmare world lives inside so many of us and is so unspeakable. They couldn't identify the bodies you see. Couldn't work out which bits belonged to who. Being part of the trauma team meant I was told things I still wish I never knew. Things I do not think I could ever tell another soul. And yet there are those there that night who carry such memories, not as whispered words the way I do, but as things they had to deal with, things they had to see. Worse, worse. worst of all. The sound of grief when groups grieve together. The keening sound we make alone in our private homes amplified by the horror of such deaths as families heard from the person who identified the body 'Yes, it is them.'"(Bradley 1999)
Forever this sound lives in my heart. Never will I forget. At 1.30 p.m. on Sunday, I left.
Counselling?
The co-ordinator of the trauma team, emphasised repeatedly that we were not there to counsel people but simply to offer them support in the immediate situation. Such guidance is in keeping with research findings which suggest that whilst information and practical help are beneficial (Brom and Kleber 1989) initial counselling interventions have negative effects (Raphael 1980, Polak et al 1975).
That may be so but from the moment I broke away from the group of social workers, psychiatric nurses and others gathered as the "trauma team", discussing what we were going to do to follow a young man in obvious distress, I was working as a counsellor. It is the most intense group work I have ever done - for something like two to three hours I worked with a group of about 30 people - the mother, brothers, uncles, aunts, and friends of the family and the way I worked with them is indistinguishable from the way in which I facilitate emotional processes in my normal working life. It was different because it felt like it was 'real time': completely here and now and us. It was different because nothing was 'introduced', there were no 'invitations to contribute' but the essential work of paying close attention to what is being shared by the person speaking and the response of others, listening, being with, understanding, accepting, communicating that all are being heard was the same. Perhaps it would have been better if there had been a second facilitator present but the situation and my response to it evolved while the 'trauma team' were still trying to work out what they were meant to be doing.
Later the work was less intense than that initial encounter but throughout the night I found that I was encountering different people in distress. Was I there as a counsellor or was I there as 'just me'? In the encounters I had with the bereaved that night, I know I used the skills I have practised as a counsellor for so many years they are as automatic as breathing. This was a tragedy that happened 'my town' and I was there, not 'because I am a counsellor' but simply because I wanted to be.
Phase 1: Knowing my values
Returning home following the intensity of this experience, initially I felt totally disorientated. I did not at any time attend any formal debriefing as a result of my involvement in the aftermath of the Omagh bombing so I have no idea if some of the difficulties I have experienced since could have been avoided. I found that I had a problem, not with my experience in Omagh but with the mundane world that continued to exist and now seemed so unreal.
Within a few days I found myself 'high' on a powerful sense of clarity and conviction regarding my central values in life. Life is a precious gift and I need to make the very best use of it that I possibly can. I made a number of major and, in hindsight, perhaps rash decisions such as simultaneously buying a house and leaving the job which provided me with the means to pay for it!
But alongside this almost euphoric reaction and sense of conviction, I did not sleep. Each night different aspects of the original situation would return to me and I would find myself weeping once again for the loss of those whom I never would have known if such a terrible tragedy had not occurred. I even wrote one person a letter at 4 a.m. one morning driven to action by the strength of my feeling for their loss. I have no idea what they made of it as they did not respond but it eased my aching heart to say how I felt.
Phase 2: Trouble brewing
I found coping with other peoples reactions difficult. Cairns and Wilson (1989) found that the major defence used by people in Northern Ireland to cope with the psychological impact of the troubles was denial. Initially it shocked me that I was encountering such a profound reluctance to acknowledge the enormity of the tragedy. Simply to respond to the question "Where are you from?" with "Outside Omagh" lead to an uncomfortable silence. I found this so painful that over a period of months it lead to my becoming increasingly isolated as my reluctance to encounter others grew.
But the greatest source of distress was that I had no further involvement with the work ongoing with those bereaved in the bomb. What is the point in my having years of experience as a counsellor and supervisor if I cannot use it now to help those who are suffering in my home town? I did every thing I could think of to make contact with those working in Omagh to offer my services but it was like facing a locked door when none of the keys I had fitted the lock.
The nights grew longer and darkener and my sorrow grew stronger. I became two people. The one who stood before a group and lectured and the one who was hidden in the room where I despaired. I suffered from the 'glass bubble effect' - a sense of being removed from everyone around me. I stopped going out of the house other than to do what I must do and sometimes I would realise that my reluctance to leave the safety of my home was developing in to something like agoraphobia.
I grew silent. I found myself crawling through the days because I didn't have the strength to walk. I felt guilty for suffering so much when I felt I had no right to hurt. I am too far removed from that inner circle of bereaved to validate the pain I feel. All that hurts me is that I do nothing. I am useless. The world would be better off if I had died instead of one of the people whose death ripped lives apart and left the bereaved in such pain.
I tried counselling. I went to someone I know professionally and trust as a person. She said that if I really wanted to be working with people affected by the bomb then I would be doing it. It was the wrong thing to say. I sent off another flurry of letters, got no response and sunk deeper into the painful impotence and isolation and self-chastisement. Once more I was wrong to feel as I felt.
I found that the image of the bomb going off, which I had not witnessed, was now permanently with me. It lived behind my eyelids. Over and over again, I would see the people walking down the street, then 'the bodies' fragmented gift to the blast'(Bradley 19991, 2).
Over and over again in the last two years I have confronted the desire for death, the wish to end the unbearable knowing that rips my heart apart. "The heart that breaks can contain the world" according to Joanna Macy (1991) and this is the thought I cling to when once more suicide grins at me and says 'Hey, this way out.' My most intense confrontation with the suicidal invitation, occurred after my first session with a man who following the break-up of his marriage had decided exactly how, where and when he was going to kill himself. I helped this individual reach a place where they were no longer suicidal but it was as if the only way I could do it was by standing there myself and confronting the intensity with which I wished I was dead and all my fantasies of how to kill myself.
Phase 3: Opening the Heart in Hell
I found salvation in the work of Stephen Levine. His book 'Healing into Life and Death' (1989) became my bible and the wisdom he shares seeped slowly into my thinking. Peter Farrell (1999) argues that our current understanding of bereavement means that we fail to confront the reality of impermanence with which death faces us and thereby miss the opportunity for spiritual growth. Stephen Levine, particularly in the grief meditation, provides us with a means for undertaking this spiritual growth. I remember vividly sitting down with a lit candle, looking at the newspaper photographs of those who died in the Omagh bomb and just let myself be as I was and weep because these people are dead and much suffering in this world is caused by such terrible events. To give myself the permission to be, to offer to myself what I automatically give every person who walks into a counselling room - validation, was powerful. In the grief meditation, the meditator is invited to let the grief in, to breathe grief into the heart, without any judgement or criticism, to open to what is present and enter into it rather than trying to shut it out or deny it. To experience "a tenderness that simply allows us to feel what we feel, the compassion with which we allow the process to unfold as at may. Go slowly and with great gentleness into the dark night of the mind that's been confronted with loss, with all the losses that each loss puts us in touch with." (p 110 Levine)
"Grief is just old mind never before so intensely experienced. The ancient guardians of our self-image, the blockages of the heart, become uniquely evident. The fear, the self-judgement, the heaviness of body dense with doubt, the guilt and anger of so many lost moments, feelings of failure, trepidation, loathing, dread and helplessness arise from just beneath the surface to present themselves in a blaze of anguished feelings. None of these qualities or experiences are new. Though few have appeared with such intensity before. Little of our ordinary grief has been acknowledged." (p106 Levine 1987)
So it was for me. The grief meditation leads to an expansion far beyond Omagh and what has happened there. I grieve for all the Omaghs everywhere, for all the cruelty and barbarism in the world - rape, incest, torture, murder, mutilation: the terrible things we do and go on doing to each other in this suffering world. And I grieve a thousand little things that hardly warrant a mention. It is as if to grieve at all, I must grieve everything. Then sometimes, and only sometimes, I find that I can "let the heart open past its longing and grief" (p 120 Levine 1987) and find the true peace of acceptance.
There are days when my heart swells with pain and others when the sore heart eases. I still have difficulty coping with contact with other people when I 'have no hat on'. The emotional intensity of my inner world is a resource to draw on when I am with people whose pain has brought them to see a counsellor but in 'normal' interactions I often experience it as a block. My emergence from the withdrawal of last year is slow and painful. I was in a shell and having cast that aside, it is taking me time to grow a skin that protects me from the rawness I experience in the ordinary interactions of this world.
But "Even though one may still feel terrible at times, the healing continues. We are not surprised at how little capacity we have at times to remain open, not surprised at how it changes, how our healing comes and goes...As the healing discovers itself, drawing from beyond all previous resources and unimaginable tenderness, we make room in our heart even when our heart is closed." (p 114 Levine)
At times it feels like the rest of my life will contain nothing other than grief and my struggle with this opening to the reality of suffering in this world. Yet I know that in my counselling work I am more available to open up to the pain inherent in the client's sharing and that the way my work has been transformed sometimes awes me.
Conclusion
If we are to accept Creamer et al. (1992) formulation of the underlying mechanism of Post-traumatic stress disorder as characterised by a pattern of intrusion and avoidance of traumatic material then it seems to me that through meditation, I have found an antidote for the development of post-traumatic stress. There are many ways in which my reaction to the Omagh bombing had aspects which correspond to those given in the diagnostic criteria for PTSD such as "recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions; markedly diminished interest or participation in significant activities, feeling of detachment or estrangement from others; difficulty falling or staying asleep; irritability or outburst of anger."(American Psychiatric Association 1994). However in entering the meditative process and embracing rather than seeking to avoid those aspects of the experience which induced fear, by choosing the spiritual growth of which Farrell speaks, the experience of life itself has been transformed.
When I open myself
To the depths of my pain
Daring to feel
Its full intensity
I touch your pain,
Our pain, the world's pain.
If I can bear
Its full intensity
And offer it up
I can also be part
Of this world's healing.
Gwen Price.
References
A P A (1994) DSM-IV Criteria for PTSD, Diagnostic and Statistical Manual of Mental Disorders, (4th Edition) Washington, DC: American Psychiatric Association.
Brom, D., and Kleber, R. J. (1989) Prevention of post-traumatic stress disorders, Journal of Traumatic Stress, 2, 335-351
Bradley, D. (1999) No More Omaghs - unpublished article
Bradley, D. (1999) Red Hands - unpublished poem
Cairns, E., and Wilson, R. (1989) Coping with Political Violence in Northern Ireland, Social Science & Medicine, 28, 6, 621-624
Creamer, M., Burgess, P., and Pattison, P. (1992) Reaction to trauma: A cognitive processing model, Journal of Abnormal Psychology, 101, 452-459
Farrell, P. (1999) The Limitations of Current Theories in Understanding Bereavement and Grief Counselling, 10, 2, 143-146
Gilbran, Kahil (1980) The Prophet, Heinemann
Joseph, S., Williams. R., and Yule, W. (1997) Understanding Post-traumatic Stress, Wiley
Levine, S. (1989) Healing into Life and Death, Gateway, Bath
Macy, J. (1991) Personal communication during Deep Ecology Workshop which I attended in England
Polak, P. R., Egan, D., Vandebergh, R., and Williams, W. V. (1975). Prevention in mental health: A controlled study, American Journal of Psychiatry, 132, 146-149
Price, G. (1998) unpublished poem.
Raphael, B. (1980) Primary prevention: Fact or fiction? Australian and New Zealand Journal of Psychiatry, 14, 163-174