Adults Burned as Children: Buried Trauma
By Megan Bronson RN, MSN, CS
It was during Phoenix World Burn Congress in Atlanta, Georgia, in 1999 that I first became aware of the profound issues of unresolved loss and trauma carried by many adult burn survivors who had suffered their burn injury as children and adolescents. I was asked to facilitate an evening group for adults burned as children, so I set up the room with six chairs in a circle and waited for people to arrive. The circle kept growing and expanding until there were 25 chairs in the circle filled by people of various ages and backgrounds.
I heard one story after another of childhoods abruptly ended by burn trauma and of unresolved, unshared emotional pain. Many people in the group described growing up not wanting to upset their parents with their feelings of anger, fear, loneliness, and the sense of feeling different from others and of sometimes feeling ostracized and stigmatized. For many, it was the first time they had ever talked about the experience of their burn injury or shared how that had affected their childhood, their life, and their relationships.
Many adults burned as children make the statement, "It is as if part of me never came back after I was burned," referring to the feeling of loss of self and emotional numbness that occur when trauma and traumatic loss are not resolved. In order to go on with life, the child buries the trauma and moves on, appearing resilient and unaffected, while in reality the effects of the unprocessed trauma and loss are deeply affecting their lives. Younger children, faced with major traumatic events, such as burn trauma, will most often use a dissociative response in an attempt to cope with the overwhelming experience of trauma. Dissociation refers to cutting off one’s feelings, perceptions, and memories of the event and, while it is adaptive at the time of the trauma, it inevitably becomes maladaptive and creates problems later on. Unresolved and unprocessed trauma and loss negatively affect the ability to be happy, intimate, trusting, and spontaneous in life.
Unresolved trauma and traumatic loss often present as one or more of the following:
- Anxiety disorders
- Obsessional thinking and compulsive behaviors
- Substance abuse and dependence
- Problems with intimacy and relationships in general
- Sleep disturbance
- Eating disorders
- Psychosomatic illness
- Aggression, hostility, irritability, controlling
- Risk-taking behaviors
- Attention difficulties
- and more...
In the years since Phoenix World Burn Congress in Atlanta, I have had the privilege of talking with many adults burned as children and adolescents who describe these kinds of life patterns and feelings of loss of a part of themselves. It has become clear to me that this subgroup within the burn survivor population requires additional support and assistance to deal with unresolved grief and trauma, as well as developmental issues. Burn trauma overwhelms the coping ability of strong and functional adults, not to mention children, whose ability to process and integrate traumatic feelings and events is not yet fully developed.
The most overwhelming emotions related to traumatic events are fear and a sense of helplessness in the face of an overwhelming and perceived life-threatening experience. Because children often experience the painful and intrusive treatment of burn injury as still being in danger, this overwhelming of coping ability goes on for sometime after the initial burn injury. The necessary yet painful and frightening treatment of burn injury prolongs the extreme stress that the child must endure. Children may also experience the necessary dressing changes, tubbing, and debridement as punishment, further confusing the child’s perception.
Inadequate or incomplete achievement of developmental tasks often occurs in the wake of trauma. This is true for the burn-injured child as well as siblings of the child who suffered the burn. It is therefore essential to consider the developmental stage the person was in when the burn injury occurred as the developmental task of that stage may have been partially or inadequately mastered. I think of the development of the human personality and psychology as similar to the building of a house. In the building of a house, the care with which the foundation is laid will determine the solidness and the structural strength of the completed house. All parts of the house rest on the foundation, just as all parts of the personality are built on the sequential developmental stages of childhood.
Erik Erickson, author of Childhood and Society, described a model of development in which each developmental stage of childhood builds upon the previous one in the psychosocial development of the child. Each stage presents a challenge to the child, and how well that challenge is mastered will determine how fully the child is able to progress to the next developmental stage. Failure to accomplish the developmental task of one stage therefore affects all subsequent stages.
The following are the developmental stages and the tasks of each of these stages as described by Erickson:
Age: First year; Developmental Conflict: Basic trust vs. mistrust; Developmental Task: Hope and trust; Failure to Achieve: Fear, pessimism, difficulties with trust
Age: 2–4 years; Developmental Conflict: Autonomy vs. shame and doubt; Developmental Task: Self esteem, sense of control, ability to exercise restraint; Failure to Achieve: Loss of a sense of control, feeling out of control
Age: 4–5 years; Developmental Conflict: Initiative vs. guilt; Developmental Task: To initiate one’s own direction, sense of purpose, and direction; Failure to Achieve: Fear of punishment, over-compensating by showing off
Age: 6–11 years; Developmental Conflict: Industry vs. inferiority; Developmental Task: Intellectual, social, physical competence; Failure to Achieve: Sense of inadequacy and inferiority
Age: Adolescent 12-14 years; Developmental Conflict: Identity vs. role confusion; Developmental Task: Relationships with peers, search for identity; Failure to Achieve: Role confusion
Age: Young Adult 15-17 years; Developmental Conflict: Intimacy vs. isolation; Developmental Task: Ability to form satisfying and long-standing attachments; Failure to Achieve: Loneliness and isolation
Trauma disrupts the mastery of these developmental tasks. Many burn centers now recognize the importance of considering the developmental stage of the child and incorporate interventions that decrease the impact of the prolonged stress of acute burn treatment on the developing child. Dr. Jeanne Dise-Lewis of the Children’s Hospital in Denver, Colorado, describes a model for intervening with children that considers developmental capacity and vulnerability. The direction for care described in her article ("A Developmental Perspective on Psychological Principles of Burn Care," Journal of Burn Care and Rehabilitation, 2001) is applicable to helping children who have suffered any sort of trauma Most adults today who were burned as children did not have the benefit of the integration of trauma research and the effects of such intervention on psychosocial healing after burn injury, and so the question remains—how to assist this population to heal and to recover.
In my experience working with people who have suffered extreme traumatic events, such as burn injury, one of the most common problems with healing trauma is finding a way to process the fear trapped in the trauma. It is this trapped fear that is at the root of posttraumatic stress symptoms.
In Too Scared to Cry: How Trauma Effects Children and Ultimately Us All, Lenore Terr, MD, describes the following fears that are common in children after trauma.:
- Fear of another more frightening event
- Fear of separation
- Fear of death
- Fear of helplessness
- The mirror image of extreme rage is extreme passivity—both are fear based
Oftentimes it is unresolved fear that unconsciously drives a trauma survivor’s life and the resolution of fear is therefore essential to recovery and healing. Journaling, support groups, and peer support, such as Survivors Offering Assistance in Recovery, are helpful places to process unresolved feelings. It can also be helpful to find an individual counselor who has experience and training in helping survivors of trauma and traumatic loss to assist in this process or healing and recovery.
Adults burned as children can use Erickson’s developmental model to identify the affect that their burn injury had on their own developmental process. Once identified, they can begin to work on renegotiating and mastering these developmental stages. Focusing energy on activities that help one to grow, master new skills, and develop one’s gifts are all ways to develop mastery in the present. The overriding goal is to move out of the fear and on with life. Taking a class, taking the risk to make a new friendship, letting go of what cannot be changed, and embracing life—all of these contribute to moving out of survival mode and into life and living. .
Dise-Lewis, J. (May/June 2001). A Developmental Perspective on Psychological Principles of Burn Care. Journal of Burn Care and Rehabilitation, 22:255–260.
Erickson, E. (1963). Childhood and Society. New York, London: WW. Norton and Company.
Terr, L.C. (1990). Too Scared to Cry: How Trauma Effects Children and Ultimately Us All. New York: Harper Collins.
Megan Bronson RN, MSN, CS, is a registered nurse and psychotherapist, specializing in grief, trauma, and traumatic loss. She is a frequent presenter at World Burn Congress and is on the professional advisory board of The Phoenix Society.
This story is an excerpt from The Phoenix Society’s® Burn Support News, Spring Edition 2004, Issue 1. Burn Support News is a tri-annual publication that contains articles on the emotional, psychological, and social aspects of burn recovery. All Rights Reserved.