Supporting Families Impacted by Stress and Trauma
When children experience a traumatic event, the entire family is affected. Often, family members have different experiences and emotional responses to the traumatic event.
When children experience a traumatic event, the entire family is affected. Often, family members have different experiences and emotional responses to the traumatic event.
Sensory triggers in the environment can be very distracting and trigger sensory overload such as feeling overwhelmed, meltdowns, or shutting down.
While the impact of trauma can have lasting affects throughout adulthood, the good news is that healing emotional wounds is possible and reactions to trauma can be improved with supports. Professional support from a therapist can help guide you down the path of healing at a pace that is appropriate since it is essential to first establish safety and stabilization, along with basic coping strategies before processing trauma memories.
Post-traumatic stress disorder is not easy to live with, and it can be incredibly challenging to witness a loved one struggle with the different symptoms that make up this disorder.
A rocky childhood. A violent assault. A car accident. If these are in your past, they could be affecting your present health.
These are all examples of traumatic events — which, in psychological terms, are incidents that make you believe you are in danger of being seriously injured or losing your life, says Andrea Roberts, a research scientist with the Harvard T.H. Chan School of Public Health. Research shows that these events can trigger emotional and even physical reactions that can make you more prone to a number of different health conditions, including heart attack, stroke, obesity, diabetes, and cancer.
Traumatic events encompass anything from a sexual assault or childhood abuse to a cancer diagnosis. Child abuse is particularly likely to affect your adult life because it occurs at a time when your brain is vulnerable — and it often occurs at the hands of people who are supposed to be your protectors, says Roberts. “By abuse, we often mean things that are a lot milder than things people typically think of as abuse. It might include being hit with a hard object, like a whip, a belt, or a paddle,” says Roberts. “The behavior doesn’t necessarily need to be illegal to induce a traumatic response.”
A child’s perception of events is as important as what actually occurred. “While a child’s life may not have actually been in danger, the child may have seen it as life-threatening,” says Dr. Kerry Ressler, a psychiatry professor at Harvard Medical School.
People who experience traumatic events sometimes develop post-traumatic stress disorder (PTSD), a psychiatric condition that affects 5% to 10% of the general population, says Dr. Ressler. It’s more common in women, affecting twice as many women as men. And it also occurs more frequently in people who have certain risk factors, including those living in poverty, soldiers in active combat, and first responders, he says. PTSD can develop after a person experiences violence or the threat of violence, including sexual violence. It may affect people who have a close relative who experienced those things as well, says Dr. Ressler. These traumatic events are generally incidents that are considered outside the ordinary and are exceptional in their intensity.
Your risk for mental and physical health problems from a past trauma goes up with the number of these events you’ve experienced. For example, your risk for problems is much higher if you’ve had three or more negative experiences, called adverse childhood experiences (ACEs), says Roberts.
While severely traumatic events are believed to have the greatest effect on long-term health, other stressful events that don’t necessarily meet the psychological definition of trauma can still cause problems. This might include a sudden death in the family, a stressful divorce, or caring for someone with a chronic or debilitating illness, says Roberts. These milder events might lead to a mental health disorder, such as anxiety or depression. “Trauma pushes your ability to cope, so if you have a predisposition toward anxiety, for example, it may push you over the edge,” says Roberts.
In addition, incidents like these can also produce PTSD-like symptoms in certain people. “When people go through traumatic or complicated grief, they can experience pretty similar symptoms to those they might experience with trauma, such as intrusive thoughts,” says Dr. Ressler.
Most of the research related to trauma and chronic disease risk has focused on childhood trauma, says Dr. Ressler. Early childhood trauma is a risk factor for almost everything, from adult depression to PTSD and most psychiatric disorders, as well as a host of medical problems, including cardiovascular problems such as heart attack and stroke, cancer, and obesity.
These effects likely reflect two factors:
Behavioral changes resulting from trauma. People who are suffering from traumatic memories may try to escape them by participating in risky behaviors such as drinking, smoking, drug use, or even overeating for comfort. “Those can all be used as a coping mechanism, a way of dealing with emotional dysregulation that occurs when someone has been traumatized,” says Roberts. These habits, in turn, lead to health problems.
Physical effects related to trauma. The problem goes beyond unhealthy habits. Experts believe that there is actually a direct biological effect that occurs when your body undergoes extreme stress. When you experience something anxiety-provoking, your stress response activates. Your body produces more adrenaline, your heart races, and your body primes itself to react, says Roberts. Someone who has experienced trauma may have stronger surges of adrenaline and experience them more often than someone who has not had the same history. This causes wear and tear on the body — just as it would in a car where the engine was constantly revving and racing, she says. Stress responses have also been demonstrated in people who have experienced discrimination throughout their lives. “It ages your system faster,” says Roberts.
Chronic stress can increase inflammation in the body, and inflammation has been associated with a broad range of illness, including cardiovascular disease and autoimmune diseases, says Roberts. Early trauma disrupts the inflammatory system. This can lead to long-term aberrations in this system and chronic health problems triggered by constant inflammation. Typically, the more trauma you’ve experienced, the worse your health is.
People who have experienced trauma may also struggle with getting help. “One of the most common outcomes of trauma is avoidance,” says Dr. Ressler. “It makes sense. If you experience something traumatic, you want to avoid thinking about it and going to places that remind you of it.” Unfortunately, health settings — with their doctors, therapists, and counselors — are triggers for many people because when someone experiences a traumatic event, he or she often ends up in the health care system.
In addition, if you’ve experienced trauma, you may believe that health care providers will want you to talk about it and dredge up feelings from the past. For these reasons, people who have experienced trauma may avoid medical care.
Some people may be in denial about the role past trauma is playing in their life. “I would say that a lot of people are unaware of how trauma is affecting them,” says Roberts. One of the hallmarks of trauma is the fact that people often use defense mechanisms to protect themselves from stress. Denial is one of those, as is trying to normalize past problems. “People may say things like, ‘oh, everybody I know got hit as a child,'” says Roberts.
Seek out resources
To get more information about trauma and PTSD or to find treatment resources, here are three very good, well-vetted websites from leading professional organizations:
If you suspect that past trauma is affecting your life, there is help. This is a treatable problem. “You don’t have to be stuck,” says Dr. Ressler. “There is a good chance that you can move past this.”
Taking steps to address the problem may also help others in your life. Very often people who have experienced trauma pass problems on to others in their family through a process called observational learning, he says. So, helping yourself may help those around you. Consider these steps.
Work with a therapist. A trained therapist can help you reframe what happened to you and help you move past it. “One of the most successful treatments is exposure therapy, where the idea is to expose yourself in small doses to the thing that was most traumatizing, with someone there to support you,” says Roberts. Treatment may also include medication to address any mental health disorders you are experiencing.
Take care of yourself. There are numerous lifestyle measures that can help you reduce stress and anxiety. These include yoga, tai chi, and meditation. Regular exercise can also help you manage stress and other symptoms.
Reach out to others. Research has shown that maintaining strong social ties with friends and family members is crucial to good mental health.
“Unfortunately, all of these things are hard to do when in depressive states,” says Roberts.
That’s why many people may need to start with therapy, and then add other strategies later on.
Police officers have high rates of heart disease and suicide and shorter life expectancy. Some might also suffer from what researchers call ‘compassion fatigue.’
Plymouth police Sgt. Jeff Dorfsman remembers he was eating dinner when a homicide call came through dispatch in the typically quiet western Twin Cities suburb. He and other officers on duty rushed to the scene.
Some officers provided cover while Dorfmsan administered first aid to the gunshot victim. He died anyway. Dorfsman said officers always have the potential stress of these sort of calls in the back of their minds. These are the calls that can jar him.
“It could be a sick child or a terminally ill patient or car crashes, it could be violence, and sometimes it’s just things you can’t unsee,” Dorfsman said. “Over time, that can be a difficult thing for some officers to process.”
Police work can be stressful and unpredictable. An officer never knows when something routine like a traffic stop can escalate into something traumatic. It’s a side of the job that not many civilians see or think about.
There’s growing concern in law enforcement that responding to traumatic calls over and over without mental health support can take a toll on officers’ well-being, and that built-up trauma can make it more challenging for officers and community members to rebuild trust between them.
Plymouth police officer Steve Thomas said cops traditionally have bottled up their feelings. After responding to calls about suicides, murders or child abuse, they’d be expected to suck it up and move on. But the Plymouth Police Department is at the forefront of providing support for officer wellness, and to giving officers tools to deal with that stress.
Thomas, who is one of the department’s designated wellness officers, said it’s typical now in Plymouth for officers to work through these calls after they happen.
“If there’s a traumatic incident, we always have debriefings of just the people involved in that incident. Nobody else can come in,” Thomas said. “Just so they can decompress and talk.”
Plymouth Police Chief Mike Goldstein remembers the first experience as a cop that really stuck with him. It was three decades ago, late in the afternoon. He was a rookie cop, patrolling alone for one of the first times, when he got a medical call.
Goldstein was the first to arrive at the home, which he says he can still pick out on the street.
“I was led to the crib and I started to try to resuscitate the infant,” Golstein said. “Then I felt a tap on my shoulder from a senior officer who, you know, was shaking his head. It was obvious that the child had passed.”
It was because of these sort of incidents, and the strain they put on career officers, that spurred Goldstein to launch the department’s officer wellness programs in 2012. The department now has four police trained as wellness officers and a part-time officer who’s a physician who mentors other officers. They’ve even got an in-house chaplain.
”We’ve done a lot to look at physical health, to look at behavioral health and to look at spiritual health,” Goldstein said. “We have programs from the time you walk into this department as a brand-new officer to the time you choose to retire.”
The department also now requires officers to meet with a behavioral health counselor at least once a year. Goldstein made that change after some officers had to take leaves of absence because of post-traumatic stress disorder.
“I really don’t care when you go in to talk to the provider what you discuss. You could stare at them for an hour, you could talk about the Minnesota Twins,” Goldstein said. “I just want them to establish a connection so that if something does trigger an emotional response and they need to talk to someone, they have a comfort level going in and they’re not starting from scratch.”
Before becoming a police officer, Mitch Martinson served in the military, where these sort of wellness services have been long established to help soldiers cope with trauma. He said the programs have helped his fellow officers understand that talking about trauma isn’t a sign of weakness.
“We would urge each other to seek help if needed,” Martinson said.
Wellness isn’t just about mental health. In recent years, the department has also built out a free gym for officers to use in the basement of the police station.
Plymouth police Detective Amy Goodwin was in the gym dead-lifting 205 pounds on a recent afternoon. She said the on-site gym gives officers an opportunity to blow off steam and talk about things other than their police work.
“It’s just a great way for officers to come down here, relieve stress and to be able to take the uniform off for a while,” Goodwin said. “We all do workouts together, so it also builds that team-building for us down here.”
This is something Goldstein emphasizes, too: Officers need to interact with people outside the profession and outside the sometimes stressful 911 calls.
“Try not to live, breathe, sleep and eat law enforcement. It’s unhealthy,” he said. “Remember: Most people are good.”
But not everyone was on board with the wellness programs right away. There was skepticism from older officers and the police union, Goldstein said. But over time, the wellness programs have become part of the culture of the department.
”They know it’s not going away. They know that it’s a benefit to them. If they don’t see it, their families do,” Goldstein said. “And I just want to promote it as effectively as we can so that it becomes contagious.”
Some observers, including Goldstein, see an explosion of interest in police officer wellness programs in Minnesota and across the country. Both the International Association of Chiefs of Police and the Department of Justice COPS program have launched programs promoting officer wellness in recent years.
At a time when fewer young people are being drawn to work in law enforcement, Goldstein, who’s 52, sees the wellness programs as a perk that may help recruit a younger generation of officers who have different expectations and fewer stigmas around issues of mental health.
“The curmudgeons that are out there, the crusty old guys,” Goldstein said, “I think that if they had an honest conversation, they would say, ‘I really wish we were doing this stuff 30 years ago because I would have benefited from it.’”
Researchers have found that police officers’ health is worse than many other professions. They have high rates of heart disease and suicide and a shorter life expectancy.
That’s partly due to the routine stresses of the job, said Daniel Blumberg, a professor of psychology at Alliant International University
“Some officers never even draw their weapon,” Blumberg said. “But all officers are going to be going to child abuse, domestic violence, fatal traffic accidents and just seeing some of the challenges of society.”
It’s not uncommon for large departments to have counseling available for officers. Blumberg said it’s about more than just supporting traumatized officers — but about city leaders appointing chiefs who put wellness at the core of their missions.
”It’s about everything from who you’re hiring, to how you train, to how you supervise implementing preventive measures,” Blumberg said.
The personal impact of stress on officers is well established. But there may also be a broader public interest in ensuring that officers mental health is taken care of. Blumberg said another thing clinicians see in police officers is what they refer to as “compassion fatigue,” which can also affect other first responders.
“It’s essentially the emotional toll taken by routinely trying to assist victims of trauma, and additionally for police officers, the futility that they often feel when it comes to preventing a crime or stopping criminals from hurting people,” Blumberg said.
“Compassion fatigue” can happen to police officers partly because of the demands of the job. Imagine an officer going from a call where a child was brutalized to a call where someone’s bike was stolen, he said.
”When you’re suffering significantly from compassion fatigue, the last thing that you want to do is connect with someone who’s in a lot of emotional pain,” Blumberg said. “So, that person comes to the scene, and is not being as helpful or supportive as that victim may need in the moment.”
Police and community relations are in the headlines all the time. Protests broke out across the country in recent years after police officers shot and killed civilians on the job.
That’s led to a climate where officers can feel like their actions are being closely scrutinized, said Jillian Peterson, a professor of criminology and criminal justice at Hamline University. She said providing mental and physical support for officers could be one way to start to rebuild trust between police and the communities they serve.
“We talk a lot about trauma that is sometimes caused by police interaction, which is a really important conversation. But I think we don’t talk as much about the trauma that police are being exposed to and how that’s impacting every interaction that they have,” Peterson said. “It’s to the public’s benefit, I think, to have these conversations.”
Mike Goldstein, the Plymouth police chief, said his goal is to make sure his officers stay healthy, so they can do a good job for their citizens.
“If I give them everything they need, they’re the ones that are then going to serve the community, they’re going to carry out our mission, and then everybody wins,” Goldstein said. “But if they’re broken, if they’re sick, if they’re not focused, if they’re stressed, then nobody wins.”
When many of us think of childhood, we imagine happy, carefree times. Tender feelings of safe, loving relationships with parents and grandparents are often remembered. Those of us who are parents ourselves know there is nothing more precious than the birth of a child and the dreams associated with watching that child grow and thrive into adulthood.
Adults also know that growing up can be painful. The wounds of childhood can persist throughout life, embodied in every muscle and organ of our bodies. Children experience trauma in similar ways as adults, including from abuse, poverty, war, injury, or other adverse events. But there is more to trauma than meets the eye.
There are subtle, often invisible, ways children suffer from trauma, the most common being the loss of human connection. Relational trauma can be experienced by children who feel misunderstood, inferior, unaccepted, emotionally neglected, or socially disconnected. These feelings damage children’s emotional health.
Today, college freshmen rate their emotional health compared to others their age at 50.7%, the lowest level ever (Eagan, et al, 2014). Numerous studies have highlighted the declining emotional health of U.S. students, including a steady rise in anxiety, depression, and mental illness (Pryor, et al., 2010; Douce & Keeling, 2014). While these statistics are a cause for concern, the good news is that researchers are beginning to better understand the links between poor mental health, relational trauma, and the brain. As a result, therapies are improving.
In recent years, neuroscientists and psychologists have studied various types of trauma and its effects on children. We know, for example, that when children experience trauma, their growth and development is disrupted. To heal and move forward, research shows that the brain must be stimulated in fresh, creative ways. More than ever, a child needs support from adults who can authentically and respectfully interact with them.
In a groundbreaking new book, Relational and Body-Centered Practices for Healing Trauma: Lifting the Burdens of the Past,psychologist Sharon Stanley, PhD, demonstrates the importance of sharing traumatic experiences in the presence of those who can see, hear, and feel the many ways our bodies communicate truth. Written primarily for helping professionals, this book also reminds us of the significant role parents, teachers, and mentors play in helping children heal from adverse events or relational trauma. In fact, the neuroscienceresearch and practices that Stanley shares should be at the heart of every healthy adult-child relationship. Gleaned from her book are three important ways all adults can become healers for the children in their lives.
The goal of rituals is to create human connections. When parents and teachers create safe spaces for children to express themselves, explore their feelings, and become aware of the sensations in their bodies, children feel what it means to be human. Stanley suggests that ceremony changes the brain in ways that convert fear to love, facilitating growth and development.
For example, when a child aches in his stomach, feels tension in her jaw, or experiences tight sensations in his chest, we can help that child more consciously connect these sensations to a deeper self-knowing. We do this through authentic listening and a sense of respect for how a child feels and experiences those feelings in his or her body. We are consciously present, helping children reflect and gain embodied self-awareness.
Through compassionate relationships based in somatic empathy, a child’s brain changes in ways that repair the effects of trauma.
The three practices listed above are everyday ways all adults can nurture deep connections with children and teenagers and help them heal from trauma. But often, children need the help of experienced psychological professionals to overcome adverse events and relational trauma in their lives. The good news is that neurobiological research with somatic, embodied healing practices is breaking new ground each year.
Stanley has trained hundreds of practitioners for over a decade in what she calls “somatic transformation.” For helping professionals who want to understand the neurobiological underpinnings of trauma and new ways to work with those affected by trauma, I highly recommend Stanley’s book, based on the most recent research and transformative practices available.
As parents and teachers, we must all become more aware of the subtle cues of relational trauma in our children and in ourselves. Through numerous case studies, Stanley demonstrates that it is never too late to heal the wounds of our own childhoods through body-based somatic healing. When we heal ourselves, we have greater capacity to be in authentic empathy-based relationships with our children.
Douce, L.A, & Keeling, R.P. (2014) A strategic primer on college student mental health. (Washington DC: American Council on Education).
K. Eagan, et al., (2014) The American Freshman: National Norms Fall 2014(Los Angeles: CA: Higher Education Research Institute, UCLA, 2014)
J.H. Pryor, et al., (2010) The American Freshman: National Norms Fall 2010(Los Angeles, CA: Higher Education Research Institute, UCLA, 2010).
S. Stanley, (2016) Relational and Body-Centered Practices for Healing Trauma: Lifting the Burdens of the Past (New York: Routledge).
Marilyn Price-Mitchell, PhD, is the author of Tomorrow’s Change Makers: Reclaiming the Power of Citizenship for a New Generation. A developmental psychologist and researcher, she works at the intersection of positive youth development and education.
You may see the signs popping up around your neighborhood this July 4—red, white and blue notices that indicate the home of a vet with the request to “Please be courteous with fireworks.”
The signs are the work of a Facebook-launched nonprofit, Military With PTSD, begun by Shawn Gourley, whose husband, Justin, served in the Navy for four years and returned with post traumatic stress disorder (PTSD). Sudden and loud noises can trigger episodes of PTSD, bringing veterans back to traumatic experiences they have lived through during their service. According to the U.S. Department of Veteran Affairs, up to 20% of military personnel who served in Iraq or Afghanistan experience PTSD each year.
The signs are posted on the lawns of veterans’ homes to alert people to be more considerate when setting off fireworks in the area. According to Gourley, who spoke to CNN, the group has mailed 2,500 signs, some of which were paid for by donations and others by the vets themselves, while 3,000 people remain on a waiting list.
The signs are not meant to quash any Fourth of July celebrations, but to raise awareness that the explosive sounds, flashes of light and smell of powder may trigger unwelcome memories for some. “If you are a veteran, on the one hand July 4th should be one of the most patriotic holidays that you feel a part of,” says Dr. John Markowitz, professor of psychiatry at Columbia University. “On the other hand, the rockets’ red glare and the bombs bursting in air are likely to evoke traumatic memories, and you might want to hide. It’s a tricky one.”
Having advanced knowledge of a fireworks display can help some people with PTSD to better prepare and cope with any symptoms they may experience. “A big component of the startle response and PTSD is the unexpected,” says Rachel Tester, program director of the Law Enforcement, Active Duty, Emergency Responder (LEADER) Program at Harvard Medical School’s McLean Hospital. “When people are able to anticipate, they are able to put into place mechanisms they have to cope ahead of time.”
That might include things such as relaxation techniques or being able to see the fireworks show and therefore know that they’re coming, as well as having headphones, music or other distractions at the ready.
Such strategies may not work for every PTSD patient, but being more aware that the explosive celebrations of the holiday might affect those with PTSD is an important step toward ensuring that everyone can enjoy the holiday without fear, anxiety or pain.
By ALICE PARK
When we think about posttraumatic stress disorder (PTSD), it’s typically in the context of active duty service members and veterans—for good reason. Dangerous and potentially traumatic situations are common occurrences in the context of military service. However, it’s important to note that PTSD is not exclusive to this type of trauma.
In the U.S., about eight million people experience PTSD. While any traumatic experience can lead to PTSD, there are a few types of trauma that are the most common. Examples include sexual assault/abuse, natural disasters, accidents/injuries to self or other, or being in a life-threatening situation. When you consider these examples, it’s understandable why people would associate PTSD most frequently with military service members. However, this assumption can be problematic.
If people believe that only service members and veterans can develop PTSD, the recognition of symptoms and treatment can be delayed. The fact is: Anyone can develop PTSD when they experience or witness a traumatic event—adult or child, man or woman. Anyone.
About 50% of all people will go through at least one traumatic experience in their lifetime. But not everyone will develop PTSD. In fact, the majority won’t. However, it can be difficult to distinguish between the typical symptoms that follow a traumatic event and when it has reached the point that a condition like PTSD has developed.
It’s common for people who experience trauma to have nightmares or flashbacks for a few weeks and then gradually improve. It’s when those symptoms don’t improve and begin to interfere with a person’s life that a mental health evaluation should be considered. A person who experiences the following intense symptoms for more than a month may have PTSD:
It’s important to note that PTSD-related symptoms may not occur immediately after the traumatic event; they may not surface until weeks or months afterwards. Another major, key difference between typical reactions and PTSD is that while most will remember the fear they felt during trauma, PTSD can cause a person to actually feel as if they are reliving that fear.
If a person feels supported by friends and family after a traumatic event, it can reduce the risk of developing symptoms of PTSD. It can also be helpful for a person to join a support group, so they can share their thoughts, fears and questions with other people who have also experienced trauma. Using healthy, positive coping strategies—such as exercise, mediation or playing an instrument—can also be helpful.
If symptoms persist, it’s essential to seek treatment. Those with PTSD typically respond better to structured therapies such as:
If you or someone you know is having a difficult time coping with trauma, these interventions can make a huge difference. PTSD is treatable. It’s more effective if treated early, but it’s never too late to get treatment no matter how long ago the trauma occurred.
Trauma is a part of life—it affects most people at some point. But that doesn’t mean it’s a mundane experience that can be ignored or brushed off. The key is to check-in on symptoms and seek care from a mental health professional if they persist.
Whether you’re a military service member, veteran, salesperson or elementary school student, PTSD has the potential to develop in any of us. And if it does, please know that help is available. No one should face PTSD alone.
Laura Greenstein is communications coordinator.
Trigger Warning: Sucide
“‘Oh, there he goes again, in one of his moods. Moody Finch. Angry Finch. Unpredictable Finch. Crazy Finch.’ But I’m not a compilation of symptoms. Not a casualty of bad parents and an even worse chemical makeup. Not a problem. Not a diagnosis. Not an illness. Not something to be rescued. I’m a person.”
This passage is from the insightful young adult novel All the Bright Places, which brings together two teenagers experiencing the hardships of mental illness, suicidal thinking and grief. This is author Jennifer Niven’s first young adult novel; in it, she uses her personal experience as a survivor of suicide to spread awareness about what it’s like to live with mental illness.
Using relatable characters, she paints a beautiful story of love and loss. Niven’s main character Theodore Finch asks himself, “Is today a good day to die?”—introducing suicide, the main theme of the book, in the very first line—as he stands on the ledge of a bell tower at his high school. Niven then introduces Violet Markey, who also finds herself on top of the looming bell tower, though she doesn’t fully understand how she got there. And so begins Finch and Violet’s ominous love story.
Throughout the book, Niven emphasizes how someone going through mental health challenges can believe that suicide is a reasonable solution to their condition. Finch regularly considers all the different ways he could end his life, logging them with a list of pros and cons. Finch’s ideations are revealed mainly to the reader, but occasionally to other characters.
Readers can see that what Finch is going through is bipolar disorder even though “depression” and “mania” are never mentioned, and he doesn’t receive his diagnosis until well into the book. Instead, Niven uses terms like “Awake,” “Long Drop” and “Asleep” to describe the cycles of his mood. As his “Long Drop” nears closer, tension builds around Finch’s frame of mind. But while he considers ending his life, he simultaneously teaches the grief-stricken Violet how to live hers.
Violet never receives any diagnosis throughout the book, but it is implied that she may be experiencing Post Traumatic Stress Disorder (PTSD) after being in a car accident that killed her older sister. She stops trying in almost every aspect of her life and isolates herself from people she used to spend time with. She refuses to be in a moving car, has consistent nightmares and can’t get herself to write—a once-favorite activity she used to share with her sister.
Finch encourages Violet to ride in a car again, to go to new places and write again. Without Finch, Violet may have taken years to fully live her life again. On the other hand, Finch’s condition only worsens with time, even as his love for Violet helps him experience “all the colors in full brightness.”
These two teenagers have more to grapple with than typical drama and nightly homework that plague everyone during the high school years. They have symptoms, stigma and the question of why life is worth living to contend with and Niven manages to showcase just how difficult mental illness is, especially during adolescence when mental health conditions often onset. The book concludes in a way that makes readers understand that when you live with mental illness, sometimes you have happy endings and sometimes you don’t.
Laura Greenstein is communications coordinator at NAMI.